INSURER FILING GUIDE
Banner|Aetna
Use this public information to prepare your packet, then confirm the route on the insurer's own page.
AT A GLANCE
Claim facts
| Member form | |
|---|---|
| Portal upload | NO |
| Portal path | No upload path: current member forms page links the Medical Benefits Request and the form directs the member to the claim destination on the ID card |
| Mail address | PLAN-DEPENDENT: Refer to the back of your ID card for claim mailing address. |
| Fax | Not published by the insurer |
| Attachments | Patient name; date of service; condition treated; relationship to employee; type of service; or provider-completed service lines with place of service, procedure code, description, type of service, charge, units, diagnosis code, provider tax ID, NPI, and provider identity and address |
| Deadline | Within 12 months of date of service in published Banner PPO documents |
| Outcome and status | Banner|Aetna member portal or Aetna Health app |
| Processing time | 30 days after all necessary information is received in published PPO documents |
| Caveats | Employer plan terms control; HMO or network-only plans may lack ordinary out-of-network benefits; individual Marketplace plans ended after 2025; Medicare and Medicaid excluded |
STEP BY STEP
Filing steps
Read date: 10-09-2026
Research steps
- Confirm the employer plan includes ordinary out-of-network benefits. Banner|Aetna ended active individual Marketplace medical plans after 2025. https://www.banneraetna.com/
- Download and complete Medical Benefits Request, GC-1654-2 (11-17), including items 1 through 19 and the release signature in item 25. Complete items 20 through 24 when other medical coverage exists. https://www.banneraetna.com/en/member-forms.html
- Attach itemized bills or have the provider complete the form's provider section. The itemized bills must state patient name, service dates, condition treated, relationship to employee, and service type. https://www.banneraetna.com/content/dam/aetna/pdfs/wwwbanneraetnacom/7-BA_Medical_Benefits_Claim_Form-GC-1654-2.pdf
- Leave item 26 unsigned to avoid authorizing direct payment to the physician or supplier. https://www.banneraetna.com/content/dam/aetna/pdfs/wwwbanneraetnacom/7-BA_Medical_Benefits_Claim_Form-GC-1654-2.pdf
- NOT PUBLISHED: a member portal or app claim-upload path. The current forms page supplies the PDF, and the form directs the member to the claim destination on the ID card, so
portal_uploadis NO. https://www.banneraetna.com/en/member-forms.html - The published PPO documents require the bill and claim form within 12 months of service and state that a complete claim is decided within 30 days. Check the member portal or Aetna Health app for claim status. https://www.banneraetna.com/content/dam/aetna/pdfs/wwwbanneraetnacom/Banner-PPO-Medical.pdf and https://www.banneraetna.com/en/resources/service-cost-overview-for-members.html
- NOT PUBLISHED: electronic-signature acceptance or claim upload constraints because no member claim-upload route is published. https://www.banneraetna.com/en/member-forms.html
Filing facts
- Portal upload: NO
- Portal: Banner|Aetna member portal
- Portal path: No upload path: current member forms page links the Medical Benefits Request and the form directs the member to the claim destination on the ID card
- Mail address: PLAN-DEPENDENT: Refer to the back of your ID card for claim mailing address.
- Fax: NOT PUBLISHED
- Attach: Patient name; date of service; condition treated; relationship to employee; type of service; or provider-completed service lines with place of service, procedure code, description, type of service, charge, units, diagnosis code, provider tax ID, NPI, and provider identity and address
- File types: NOT APPLICABLE
- File size limit: NOT APPLICABLE
- Maximum files: NOT APPLICABLE
- One file or separate files: NOT APPLICABLE
- Confirmation: Written decision and EOB; member portal and Aetna Health app show claims
- Status check: Banner|Aetna member portal or Aetna Health app
- Processing time: 30 days after all necessary information is received in published PPO documents
- Member deadline: Within 12 months of date of service in published Banner PPO documents
- Deadline basis: YES: current employer plan document controls
- Mental health route: Common claim form authorizes mental-health information; no separate psychotherapy member submission route is published
Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.
Read on 10-09-2026 from https://www.banneraetna.com/content/dam/aetna/pdfs/wwwbanneraetnacom/7-BA_Medical_Benefits_Claim_Form-GC-1654-2.pdf. Confirm the address, fax number or portal path on the insurer's own claims page before you send.