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This version of the form is not currently in use and is provided for reference only. Download this version of
Form HCA-105
for the current year.
Form HCA-105 Appeal of Health Claim or Precertification Denial by Aetna - Alaska
What Is Form HCA-105?
This is a legal form that was released by the Alaska Court System - a government authority operating within Alaska. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form HCA-105?A: Form HCA-105 is an appeal form used to appeal a health claim or precertification denial by Aetna.
Q: What can I use Form HCA-105 to appeal?A: You can use Form HCA-105 to appeal a health claim or precertification denial by Aetna.
Q: What should I include when submitting Form HCA-105?A: When submitting Form HCA-105, you should include any supporting documentation relevant to your appeal.
Q: How long do I have to submit Form HCA-105?A: You should submit Form HCA-105 within the time frame specified by Aetna for appealing a denial.
Q: What happens after I submit Form HCA-105?A: After you submit Form HCA-105, Aetna will review your appeal and provide a decision in writing.
Q: What if my appeal is denied?A: If your appeal is denied, you may have additional options to further appeal the decision, such as requesting an external review.
Form Details:
- Released on January 1, 2018;
- The latest edition provided by the Alaska Court System;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form HCA-105 by clicking the link below or browse more documents and templates provided by the Alaska Court System.
Download Form HCA-105 Appeal of Health Claim or Precertification Denial by Aetna - Alaska
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