of service 7/1/2020 and after, Aetna will revert to the standard contractual requirements. Timely Filing Requirements of Claims New claims must be submitted within 180 calendar days from the date of service. Claims will deny if not received within the required time frames. The ABA Medical Necessity Guidedoes not constitute medical advice. This Agreement will terminate upon notice if you violate its terms. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Please be sure to add a 1 before your mobile number, ex: 19876543210. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Mail to: full name (first and last name)address/zip code/email/etc. (you might need to provide some information to confirm your identity)date of birthsocial security numberhealth insurance policy numbermember number (Aetna member number)your billing information (if the question is about a bill) PO Box 14079 If you have any questions, please contact our Provider Service Center at the following: Aetna Claim Address And Aetna Provider Phone Number: Aetna Medicare Providers Claim Address and Phone Number, Statewise Aetna Plan Phone number and Claim Address, Liberty Mutual Disability Insurance|A Comprehensive Guide, co197 Denial Code|Description And Denial Handling. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Please help ensure your clients dont miss this critical step! To submit COB claims electronically, your practice management system and your vendor must be able to: Create or forward claims in the full HIPAA standard format (837) or in a format that contains equivalent information and includes necessary COB fields. For your convenience, we recommend that you add your Member Services number to your phone contacts. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. The link to NCCI on the Centers for Medicare & Medicaid Services (CMS) website is www.cms.gov/nationalcorrectcodinited/. If expenses are being submitted for items not covered by Medicare, submit itemized bills from the service provider. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Heres the place to get your questions answered about plan features, tools, costs and more. All services deemed "never effective" are excluded from coverage. Aetna Medicare Grievance & Appeals Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. This type of complaint does not involve coverage or payment determinations. This section relates to information about the patient. 1-855-335-1407 (TTY: 711), 7 days a week, 8 AM to 8 PM. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. 2. Serious Reportable Events Policy. P.O. You can also call us at the number on your ID card for personal service. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). This is the phone number for the Corporate Contact Center. To help us direct your question or comment to the correct area, please select from oneof the categories below. For all other Products Provider Dispute Inquiries (PPO and Commercial HMO plans): Contact the Provider Service Center at 1-888-MD-Aetna (632-3862). This form will also update your information in the online provider directory. TN, WA, Address If you have questions regarding the status of a claim (for instance, whether it has been paid or processed), use our Claim Status Inquiry transaction. Go to the American Medical Association Web site. Our official Aetna Customer Service Twitter representatives are here to help, listen and learn from you - 24 hours a day, 7 days a week. We are expecting an increase in membership for our Medicare Advantage (MA) preferred provider organizations (PPOs). WebClaims - if you have questions about claims, contact the Provider Service Center (see list below) Credentialing - 1-800-353-1232 (TTY: 711) Dental providers - 1-800-451-7715 In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Thanks, Coupon "NSingh10" for 10% Off onFind-A-CodePlans. Torequest participation in First Health networks, follow the link below. Contact us by phone. The Provider Service Center helps with contracting, patient services, precertification and many other questions. HMO and Medicare Advantage - 1-800-624-0756 (TTY: 711) Indemnity and PPO-based plans - 1-888-MD AETNA ( 1-888-632-3862) (TTY: 711) Voluntary plans - 1-888-772-9682 (TTY: 711) Worker's comp - 1-800-238-6288 (TTY: 711) The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Applicable FARS/DFARS apply. BE SURE TO KEEP COPIES OF CLAIMS SUBMITTED FOR YOUR FILES, MAIL CLAIMS TO: Do you want to continue? Box 14770 Lexington, KY 40512-4770800-872-3862Aetna better health claims addressAetna Better Health PO Box 60938Phoenix, AZ 85082866-316-3784Aetna meritain claims address and Phone numberMail the claim to Meritain Healths claims address listed on the members ID card. No referrals are required to see members enrolled in these plans. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Fax Number: Avoid the additional cost of submitting duplicate claims by using the Claim Status Inquiry to check the status of claims prior to resubmitting. WebContact Us Close Menu Contact Us Questions? If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. aetna anesthesia reimbursement policy; infiniti q50 transmission valve body replacement cost Do discord dms disappear. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. The information you will be accessing is provided by another organization or vendor. Lexington, KY 40512. Indicate which type of covered person you are. Others have four tiers, three tiers or two tiers. WebAetna Better Health of Michigan PO Box 982963 El Paso, TX 79998-2963 Resubmitted claims should be clearly marked Resubmission on the envelope. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). This search will use the five-tier subtype. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. Copyright 2015 by the American Society of Addiction Medicine. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Health benefits and health insurance plans contain exclusions and limitations. Aetna All dental claims should be mailed to GEHA at the appropriate address below: Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Aetna Amerihealth Caritas Directory Healthcare, Health Insurance in United States of America, Place of Service Codes List Medical Billing. Provider termination form and directory update. TX, VA, VT, WI, WV, WY Dont forget to include the primary care physician (PCP) on the enrollment application We encourage all applicants to select a PCP when enrolling for a plan. Reimbursement and claims processing information. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. We will pay Medicare-allowable rates to you for clean claims for covered services, less the member copayment, coinsurance and/or deductible, as described and required under MA regulations and the members MA PPO plan. Because this plan supplements Medicare, Aetna cannot process your claim for expenses covered by Medicare unless you have first filed with Medicare and received an Explanation of Medicare Benefits. Please fill in all fields. Please log in to your secure account to get what you need. All our content are education purpose only. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Disclaimer of Warranties and Liabilities. Register as a new user. Fir plywood Marine A/B 3/4" x 48" x 96". The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. This helps ensure the right PCP is assigned to the members file. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. CPT is a registered trademark of the American Medical Association. CPT only Copyright 2022 American Medical Association. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. LEXINGTON KY 40512-4100 800-424-4047, PO BOX 14586 Treating providers are solely responsible for dental advice and treatment of members. It is only a partial, general description of plan or program benefits and does not constitute a contract. Visit the secure website, available through www.aetna.com, for more information. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. This search will use the five-tier subtype. Aetna address and Aetna Provider Phone Number for Claims Complete list: Denials with solutions in Medical Billing, Denials Management Causes of denials and solution in medical billing, CO 4 Denial Code The procedure code is inconsistent with the modifier used or a required modifier is missing, CO 5 Denial Code The Procedure code/Bill Type is inconsistent with the Place of Service, CO 6 Denial Code The Procedure/revenue code is inconsistent with the patients age, CO 7 Denial Code The Procedure/revenue code is inconsistent with the patients gender, CO 15 Denial Code The authorization number is missing, invalid, or does not apply to the billed services or provider, CO 17 Denial Code Requested information was not provided or was insufficient/incomplete, CO 19 Denial Code This is a work-related injury/illness and thus the liability of the Workers Compensation Carrier, CO 23 Denial Code The impact of prior payer(s) adjudication including payments and/or adjustments, CO 31 Denial Code- Patient cannot be identified as our insured, CO 119 Denial Code Benefit maximum for this time period or occurrence has been reached or exhausted, Molina Healthcare Phone Number claims address of Medicare and Medicaid, Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit, Kaiser Permanente Phone Number Claims address and Timely Filing Limit, Amerihealth Caritas Phone Number, Payer ID and Claim address, ICD 10 Code for Sepsis Severe Sepsis and Septic shock with examples, Anthem Blue Cross Blue Shield Timely filing limit BCBS TFL List, Workers Compensation Insurances List of United States, Workers Compensation time limit for filing Claim and reporting in United States. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Box 14770 Lexington, KY 40512 1-800-264-4000 Hours: The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. CPT only copyright 2015 American Medical Association. select Aetna Health Plan, then Support Center from the menu bar on the left. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Aetna While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. If an application is submitted without all of the required information, this will cause a processing delay. Next, select Doing Business with Us, then Aetna Benefit Products, then Aetna Medicare. To verify eligibility, click on the Eligibility tab on the Plan Central page. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Or, call your vendors customer service help line. Links to various non-Aetna sites are provided for your convenience only. PO Box 981106 The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. PO Box 398106. Insurance Denial Claim Appeal Guidelines. Aetna Member Services Aetna Address for Member Services; Corporate Headquarters: 151 Farmington Avenue Hartford, CT 06156: Aetna addresses for Please log in to your secure account to get what you need. Some subtypes have five tiers of coverage. Be sure to have your student ID number. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). Each main plan type has more than one subtype. For Medicare Products Provider Dispute Inquiries HMO plans only: Contact the Provider Service Center at 1-800-624-0756. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. All Rights Reserved to AMA. If you are an Aetna member with questions about your coverage, please refer to our Member Services page for login information and additional ways to contact us. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. The member's benefit plan determines coverage. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). 1. Lexington, KY 40512 No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Reprinted with permission. Claims Inquiries To confirm the recorded date of claims receipt or to make other inquiries about claims, you may call Aetna at 1-800-624-0756 for Medicare HMO Products / 1-888-MD-Aetna (632-3862) for All Other Products, or contact your clearinghouse vendor. Links to various non-Aetna sites are provided for your convenience only. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. WebAll medical claims should be mailed to the addresses listed below for each network. Biometric Screenings. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Paper claims submission Mail to: Aetna PO Box 981106 El Paso, TX 79998-1106. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Visit the secure website, available through www.aetna.com, for more information. B. Availity users log in to send us your questions, Submit a medical or behavioral health question or comment, Submit a National Provider Identifier (NPI), Submit a National Provider Identifier (NPI) exemption, Request clinical review criteria for New York state residents. New and revised codes are added to the CPBs as they are updated. ICD 10 Code for Obesity| What is Obesity ? CPT is a registered trademark of the American Medical Association. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Please be sure to add a 1 before your mobile number, ex: 19876543210. Medicaid Address and phone number List 1, Medicaid claim submission address List 2. Call Aetna Mail Order Drug at 1-866-612-3862 (TTY: 711). Where to turn for help Depending on your situation, you have a variety of resources to help you find the answers youre looking for: Treating providers are solely responsible for medical advice and treatment of members. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. NAIC Coordination of Benefits Policy. Well need to terminate your existing agreement with us. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). Federal No Surprises Act. For language services, please call the number on your member ID card and request an operator. Box 10462 Van Nuys, CA 91410 Want to become a participating dentist? CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. CO, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD, ME, MI, MN, MO, MT, NE, ND, NH, NJ, NY, OH, OK, PA, RI, SD, TX, VA, VT, WI, WV, WY, Address Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Credentialing and joining our network - 1-800-353-1232 (TTY: 711). In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Links to various non-Aetna sites are provided for your convenience only. Your benefits plan determines coverage. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Medicare limiting charges apply. 1-800-358-8749 (TTY: 711), Monday to Friday, 8 AM to The information you will be accessing is provided by another organization or vendor. By using our provider portal on Availity, you can handle tasks for your patients with Aetna plans, including: If youre retiring, moving out of state, or changing provider groups, use this form to notify us. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Do not include any dashes, suffixes or spaces. Aetna Medicare Grivance submission address. You are now being directed to the CVS Health site. Treating providers are solely responsible for medical advice and treatment of members. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Join us in a conversation about the future of healthcare. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. You are now being directed to the CVS Health site. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.