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Clinical questionnaire for prior authorization requests

It’s easier than ever to request authorizations for selected procedures and submit requested clinical information on the Availity® provider portal.

What are the selected procedures?

What are the selected procedures?

  • Gastroplasty and gastric revision
  • Bone-anchored hearing aid (BAHA)
  • Cochlear implant
  • Endoscopic nasal balloon dilation
  • Functional endoscopic sinus surgery (FESS)
  • Frozen embryo transfer
  • Inpatient electroencephalographic (EEG) video monitoring
  • Dorsal column stimulator
  • Spinal fusion
  • Orthognathic
  • Hip or knee replacement
  • Hip or knee surgery to repair impingement syndrome
  • Shoulder replacement
  • Apronectomy, Lipectomy and Panniculectomy
  • Blepharoplasty and Canthopexy
  • Breast reconstruction
  • Breast reduction
  • Excessive skin excision
  • Venous ligation
  • Discharge verification and disposition
  • Pre-implantation genetic testing

Inpatient services clinical questionnaires


We’re creating a new clinical questionnaire for inpatient services. Soon, you’ll be able to let us know why your patient needs to extend their stay. There’s no need to call us or fax medical records. And you can get a decision right away. You’ll access it through our provider portal on Availity, just like the other ones you complete today. We’ll let you know once it’s ready.

How to authorize services and submit clinical information

We’ve simplified the process. Just follow these steps.

Step 1: Submit your initial request on Availity using the Authorization (Precertification) Add transaction.

Don’t have Availity access?

Set up Availity account

Step 2:
Complete a short questionnaire, if asked, to give us clinical information.

That’s it! You may get an approval right away after completing the questionnaire. There’s no need to call in requests or fax medical records.

Learn more about the clinical questionnaire

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

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