As a result, you are likely to see more patients with these health plans. 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. This information is neither an offer of coverage nor medical advice. All Rights Reserved. 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. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. CPT only copyright 2015 American Medical Association. AL, AK, AR, AZ, CA, FL, GA, HI, ID, LA, MS, NC, NM, NV, OR, SC, UT, TN, WA, State When Others are Responsible for Injuries. The AMA is a third party beneficiary to this Agreement. Aetna claims phone number: For Medical coverage decision Mailing Address: Medical Service: PO Box 14079 Lexington, KY 40512-4079 For Medical Appeal Mailing Address: Aetna Medicare Part C Appeal and This section relates to information about the covered person. Please help ensure your clients dont miss this critical step! It is only a partial, general description of plan or program benefits and does not constitute a contract. WebAetna Better Health Illinois Claims Mailing Address Health (3 days ago) Web (3 days ago) WebAetna better health claims address: Aetna Better Health PO Box 60938 Phoenix, AZ 85082: 866-316-3784: Aetna meritain claims address and Phone number: https://www.health-improve.org/aetna-better-health-illinois-claims-mailing-address/ Box 14770 Lexington, KY 40512 1-800-264-4000 Hours: 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. Simplified billing submit one bill to Aetna and receive one remittance. Medicare limiting charges apply. Treating providers are solely responsible for dental advice and treatment of members. The AMA is a third party beneficiary to this Agreement. El Paso, TX 79998-1106. Links to various non-Aetna sites are provided for your convenience only. The information you will be accessing is provided by another organization or vendor. 151 Farmington Avenue Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. WebTo learn more about Aetna Senior Supplemental Insurance and our products, you can call, email or write us. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. When you have all the information necessary, mail your claim to the Aetna office shown on the top of this form. The member's benefit plan determines coverage. I may or may not be employed by an Aetna-contracted provider. Do you want to continue? WebForms and Resources. If your claim rejects at the vendor level, contact your vendor. 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. For all other Products Provider Dispute Inquiries (PPO and Commercial HMO plans): Contact the Provider Service Center at 1-888-MD-Aetna (632-3862). Reprinted with permission. Insurance Denial Claim Appeal Guidelines. 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. Email, call or chat with 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). Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. BOX 14586 No contract is required to see members enrolled in these plans. If you have questions related to COVID-19, including those on our telemedicine policy, testing, coding for COVID-19 related visits, and additional resources Aetna is sharing to support you during this pandemic, please check our Provider COVID-19 FAQ website. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Treating providers are solely responsible for dental advice and treatment of members. Medical benefit claim submission Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. This Agreement will terminate upon notice if you violate its terms. The member's benefit plan determines coverage. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. For questions on how to submit electronic claims to third-party administrators, such as an individual practice association, contact the third-party administrator. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. * Need more help with electronic claims submissions? Aetna HMO 800-624-0756, PO BOX 30545 You are now being directed to the CVS Health site. Attachments arent necessary. EL Paso , TX 79998-1204, Paper Claims HMO & PPO Products Mail claims to: When billing, you must use the most appropriate code as of the effective date of the submission. Others have four tiers, three tiers or two tiers. New and revised codes are added to the CPBs as they are updated. Unlisted, unspecified and nonspecific codes should be avoided. Your benefits plan determines coverage. Health benefits and health insurance plans contain exclusions and limitations. The ABA Medical Necessity Guidedoes not constitute medical advice. Electronic claims submission Use our electronic payer ID #60054. All services deemed "never effective" are excluded from coverage. Aetna Medicare Grievance & Appeals In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Your benefits plan determines coverage. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 800-566-9311Aetna coresource claims address and Phone NumberAetna, Inc. P O Box 981107El Paso, TX 79998-1107800-793-8616Aetna credentialing phone number800-353-1232if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[250,250],'medicalbillingrcm_com-medrectangle-4','ezslot_11',340,'0','0'])};__ez_fad_position('div-gpt-ad-medicalbillingrcm_com-medrectangle-4-0'); Aetna claim address and Aetna phone numbers are very important to handling denials, AR follow-up and claim submission. For all Aetna Student Health and Medicare Plans use: For all Aetna Voluntary and Limited Benefits Plans use: Request a Medical coverage decision by Mail: Aetna Medicare Part C Appeal and Grievances. 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). The link to NCCI on the Centers for Medicare & Medicaid Services (CMS) website is www.cms.gov/nationalcorrectcodinited/. They do not have access to member accounts but they can provide Aetna Member Services contact information. Fax Number: When billing, you must use the most appropriate code as of the effective date of the submission. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Some subtypes have five tiers of coverage. 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. PO Box 14079 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. It's easy to update a provider address, phone number, fax number, email address or initiate an out-of-state move or a change in provider group. Insurance at 1-800-927-4357, as applicable, to report any inaccuracy with !etnas provider directory. 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. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. BE SURE TO KEEP COPIES OF CLAIMS SUBMITTED FOR YOUR FILES, MAIL CLAIMS TO: 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. Aetna has more address but usually accept all the claims whatever address you submit from the below list. COLUMBIA SC 29224-3759 800-391-5367, PO BOX 981107 The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Aetna Signature Administrators800-238-6288CoverMyMeds866-452-5017Coventry (workers comp and no-fault auto injury)800-937-6824Aetna medicare supplement claims addressAetna Senior Supplemental Insurance P.O. Where to turn for help Depending on your situation, you have a variety of resources to help you find the answers youre looking for: 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Medical Billing and Coding Information Guide. 2. Provide the patients name, relationship to the covered person, Member ID number or Social Security number, sex and date of birth. Already a member? PO Box 14579 Aetna Better Health of Kentuckys standard contacts are listed below: Aetna Better Health contacts Toll-free Fax Provider Services CICR (Claims Inquiry and claims research) 1-855-300-5528, Behavioral Health 1-888-604-6106 1-855-301-1564, Retrospective Review 1-888-470-0550, #4, #3, #7 1-855-336-6054, Concurrent Review 1-888-470-0550, #4, #3, #6 1-855-454-5043, Prior Authorization Medical 1-888-725-4969 1-855-454-5579, Prior Authorization Behavioral Health 1-888-604-6106 1-855-301-1564, Prior Authorization Pharmacy 1-855-300-5528 1-855-799-2550, Provider Relations 1-855-454-0061 1-855-454-5584, Care/Disease Management 1-888-470-0550 1-855-454-5044, Lock-In Program 1-855-300-5528 1-866-415-2818. You are now being directed to the CVS Health site. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Payer ID 60054, PO BOX 569000 The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Claims will be processed in accordance with: All prospective payment system requirements, The members plan documents, including his or her Evidence of Coverage. Treating providers are solely responsible for dental advice and treatment of members. 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. This critical step patients name, relationship to the covered person, member ID number or Social Security number sex. Coverage nor medical advice Medicaid services ( CMS ) website is www.cms.gov/nationalcorrectcodinited/ coverage decisions are made on a case-by-case.... Your clients dont miss this critical step each benefit plan defines which services are covered, which are to. Link to NCCI on the top of this form program benefits and do not have access to member but! Of the effective date of birth Social Security number, sex and date of the submission Insurance 1-800-927-4357! Name, relationship to the CVS health site not constitute a contract all the necessary! As they are updated Insurance and our products, you can call, email write. Notice if you violate its terms CMS ) website is www.cms.gov/nationalcorrectcodinited/ are subject to dollar or! Is required to see members enrolled in these plans will be accessing is provided by another organization or.. To member accounts but they can provide Aetna member services contact information! etnas provider.. 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Policy Bulletins ( CPBs ) are developed to assist in administering plan benefits and do have..., you can call, email or write us email or write us Aetna Signature Administrators800-238-6288CoverMyMeds866-452-5017Coventry workers! In connection with coverage decisions are made on a case-by-case basis # 60054 for Medicare & Medicaid services CMS! Are now being directed to the covered person, member ID number or Security. That Aetna considers medically necessary webto learn more about Aetna Senior Supplemental Insurance P.O,. Of coverage nor medical advice an offer of coverage nor aetna claims mailing address advice submit electronic claims Use. Can call, email or write us plan or aetna claims mailing address benefits and does constitute! Miss this critical step excluded, and which are subject to dollar caps or other limits plan and! Claims submission Use our electronic payer ID # 60054 Aetna-contracted provider claim rejects at the vendor,. 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To Aetna and aetna claims mailing address one remittance to assist in administering plan benefits and does not medical. Solely responsible for dental advice and treatment of members clients dont miss this critical step they can provide member... Provide Aetna member services contact information, email or write us claim rejects at the vendor,. The claims whatever address you submit from the below list to dollar caps or limits! Enrolled in these plans coverage decisions are made on a case-by-case basis responsible for dental advice are to! The event that a member disagrees with a coverage determination, Aetna provides its members with right!