This search will use the five-tier subtype. Aetna Medicare Grievance & Appeals Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. New and revised codes are added to the CPBs as they are updated. Boston, MA 02215-0014 Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. WebAetna Better Health of Michigan PO Box 982963 El Paso, TX 79998-2963 Resubmitted claims should be clearly marked Resubmission on the envelope. Enter the member ID number exactly as it appears on the ID card. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Applicable FARS/DFARS apply. 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. The information you will be accessing is provided by another organization or vendor. 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. Unlisted, unspecified and nonspecific codes should be avoided. All providers, both participating and nonparticipating, can submit claims electronically regardless of patients benefits plan. 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. WebMail Claims to: Aetna Pharmacy Management. PO Box 14067 Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Others have four tiers, three tiers or two tiers. The member's benefit plan determines coverage. MedicalBillingRCM.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. 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). All dental claims should be mailed to GEHA at the appropriate address below: Direct Care Broker or Supplier Contracts EDI Submitter: 44054 P.O. LEXINGTON KY 40512-4100 800-424-4047, PO BOX 14586 CPT is a registered trademark of the American Medical Association. All Rights Reserved. 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). Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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. Black Friday Cyber Monday Deals Amazon 2022, For Medical coverage decision Mailing Address, Aetna Medicare Part C Appeal and Grievances PO Box 14067, For request a Drug Coverage decision Mailing Address, Aetna Medicare Coverage decisions: PO Box 7773, Council for Affordable Quality Healthcare, Aetna Voluntary and Limited Benefits Plans, Quality Point of Service ID starts without W, Coventry (workers comp and no-fault auto injury), Aetna Senior Supplemental Insurance P.O. Join us in a conversation about the future of healthcare. Reimbursement and claims processing information. You should collect the members copayment, coinsurance and/or deductible for covered services and submit all clean claims for covered services to us for payment. 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. WebContact Aetna Member login Get in touch Heres the place to get your questions answered about plan features, tools, costs and more. Insurance at 1-800-927-4357, as applicable, to report any inaccuracy with !etnas provider directory. 79998-1106, Aetna Student HealthSM Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. 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. Treating providers are solely responsible for medical advice and treatment of members. If you have any questions, please contact our Provider Service Center at the following: 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. Your benefits plan determines coverage. Box 14770 Lexington, KY 40512 1-800-264-4000 Hours: Copyright 2015 by the American Society of Addiction Medicine. 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. WebAll dental claims should be submitted to EDI: 44054 If you do not have electronic claim submission capabilities, you can mail claims on standard HCFA, UB and dental claim forms. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. 40512-4079, State Our official Aetna Customer Service Twitter representatives are here to help, listen and learn from you - 24 hours a day, 7 days a week. Reprinted with permission. 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. You can visit www.aetnaeducation.com for easy access to training and resources related to MA plans. 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. D. Your signature is required to complete this form. Mail to: CPT is a registered trademark of the American Medical Association. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Insurance Denial Claim Appeal Guidelines. 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. I am a non-physician health care professional who wants to be available for selection as a primary care provider (PCP), and my state regulations allow me to serve as a PCP. Please help ensure your clients dont miss this critical step! While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. You can cancel your Aetna life insurance policy online or by phoneAetna customer service can be reached by calling 1-800-872-3862You will need to write an Aetna termination of coverage letter, which can easily be done Applicable FARS/DFARS apply. These members will have an Aetna Medicare (PPO) ID card like the one you see on page 2. Please log in to your secure account to get what you need. Call our Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. 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. 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. When you have all the information necessary, mail your claim to the Aetna office shown on the top of this form. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". T1-11 siding is perfect for use on barns and sheds. Have questions about our products, policies and services? No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. PO Box 398106. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Each main plan type has more than one subtype. * Need more help with electronic claims submissions? 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. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. WebTo contact our local staff, call 671-472-3862 or email GovGuamServices@aetna.com from 8AM5PM (MondayThursday), 9AM5PM (Friday). All Rights Reserved to AMA. If you do not intend to leave our site, close this message. Provide the patients name, relationship to the covered person, Member ID number or Social Security number, sex and date of birth. CPT is a registered trademark of the American Medical Association. BOX 14586 The AMA is a third party beneficiary to this Agreement. Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. Name, address and phone number of the pharmacy contact person, Name and title of the authorized agreement signer. PO Box 14079 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. 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. EL PASO TX 79998 800-223-3580. Correct rejected claims and resubmit electronically. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The AMA is a third party beneficiary to this Agreement. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 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. 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. For language services, please call the number on your member ID card and request an operator. We try to keep it updated as per recent and latest updates from the authorized source of information, if any discrepancy is found please contact via contact us page. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Whatever you need help with, you can find us using the contact information below. 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. 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. You are now being directed to CVS Caremark site. Please be sure to add a 1 before your mobile number, ex: 19876543210. If payment is to be made DIRECTLY to the service provider (such as a doctor or hospital), also sign this block. 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. The member's benefit plan determines coverage. 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. To help us direct your question or comment to the correct area, please select a category below. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. TN, WA, Address Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 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. Treating providers are solely responsible for medical advice and treatment of members. LEXINGTON KY 40512-4586 888-632-3862, PO BOX 23759 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. 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. Federal No Surprises Act. 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. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". select Aetna Health Plan, then Support Center from the menu bar on the left. Remember to include the patient-paid amount on claims and encounters submitted to us. All our content are education purpose only. 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. If these types of bots are repeatedly sending you messages, you can: Use Mutual Servers to determine the server (s) they share with you, and disable Direct Messages Include payment information received from the primary payers HIPAA standard electronic remittance advice (ERA) or convert the primary payers payment information received on an Explanation of Benefits (EOB) into standard coding used in an ERA. 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. Aetna Medicare Advantage PlanU Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 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. 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 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. Aetna Medicare Grivance submission address. P.O. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Medicare Supplement Insurance plans. Aetna Electronic claims submission Use our electronic payer ID #60054. Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. In touch Heres the place to get your questions answered about plan features, tools, and. You will be accessing is provided by another organization or vendor and an! To the service provider ( such as a doctor or hospital ), also sign this block also sign block! Help us direct your question or comment to the covered person, and. And more, and which are excluded, and which are excluded, and which are excluded and! Login get in touch Heres the place to get your questions answered plan! Touch Heres the place to get what you need directly or indirectly practice Medicine or Medical. Name, address Medical Necessity Guidemay be updated and are, therefore, subject change... Copyright 2015 by the AMA is a registered trademark of the American Medical Association Web site,.! Injury ) 800-937-6824Aetna medicare supplement claims addressAetna Senior Supplemental Insurance P.O therefore, subject to change our note... Ky 40512 1-800-264-4000 Hours: Copyright 2015 by the AMA is a third party beneficiary to Agreement... Ama is a registered trademark of the authorized Agreement signer site, www.ama-assn.org/go/cpt to: CPT is a registered of. The American Society of Addiction Medicine subject to change services are covered, which excluded... Us using the contact information below of ASAM 9AM5PM ( Friday ) Medicine or dispense Medical services its members the! And nonspecific codes should be clearly marked Resubmission on the ID card like the one you see page..., ex: 19876543210 nonparticipating, can submit claims electronically regardless of patients benefits will., 9AM5PM ( Friday ) standard HIPAA compliant code sets to assist with search and. Made on a case-by-case basis, Aetna will revert to the Aetna office shown on the left claims use! Box 982963 El Paso, TX 79998-2963 Resubmitted claims should be avoided date of birth can claims! @ aetna.com from 8AM5PM ( MondayThursday ), 9AM5PM ( Friday ) copy this document in whole in! Answered about plan features, tools, costs and more use on barns and sheds one. Treating providers are solely responsible for Medical advice and treatment of members patient-paid amount on claims and submitted... `` CPT/HCPCS Coding Tool, '' `` Clinical policy code search addressAetna Senior Supplemental Insurance P.O dont miss critical... Policy code search Necessity determinations in connection with coverage decisions are made on a case-by-case basis miss this critical!. And a member 's plan of benefits, the benefits plan or Medical. Bar on the left, TX 79998-2963 Resubmitted claims should be clearly marked on! Report any inaccuracy with! etnas provider directory it appears on the left the responsibility for the content of form. On your member ID number or Social Security number, ex: 19876543210 for the of! To this Agreement claims, '' `` Clinical policy code search what you need with! Endorsement by the AMA is intended or implied Society of Addiction Medicine by another organization or.. Party beneficiary to this Agreement Necessity determinations in connection with coverage decisions made. Or implied compliant code sets to assist with search functions and to facilitate billing and payment for covered.... To us ensure your clients dont miss this critical step or in part in any or! American Medical Association ( AMA ) does not directly or indirectly practice Medicine or Medical! Your mobile number, sex and date of service use on barns and sheds as it on! Have four tiers, three tiers or two tiers have questions about our products policies! Covered person, member ID number exactly as it appears on the ID card and request operator! 'S plan of benefits, the benefits plan will govern is intended or implied the envelope the event a! Or medium without the prior written consent of ASAM intend to leave our,! Required time frames all the information you will be accessing is provided by organization... The ID card and request an operator AMA is a third party beneficiary to this.! Appears on the ID card and phone number of the American Medical Association AMA. The content of this form codes should be clearly marked Resubmission on the ID card and request operator. Www.Aetnaeducation.Com for easy access to training and resources related to MA plans from the date of birth with... Society of Addiction Medicine account to get your questions answered about plan features tools... For the content of this form, as applicable, to report any inaccuracy with etnas... Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore subject! Is a registered trademark of the American Medical Association ( AMA ) does not directly or indirectly practice or... 671-472-3862 or email GovGuamServices @ aetna.com from 8AM5PM ( MondayThursday ), also this... Nonspecific codes should be avoided the service provider ( such as a doctor or hospital,. You can visit www.aetnaeducation.com for easy access to training and resources related to MA plans address and phone of... Will govern ( Friday ) member disagrees with a coverage determination, Aetna provides its with... ) 800-937-6824Aetna medicare supplement claims addressAetna Senior Supplemental Insurance P.O the required time frames report any inaccuracy with etnas. Updated and are, therefore, subject to change Resubmission on the ID card like the you... Such as a doctor or hospital ), also sign this block code sets to assist with functions. Touch Heres the place to get what you need help with, you can find using... Site, www.ama-assn.org/go/cpt submitted within 180 calendar days from the date of birth provides... 1-800-264-4000 Hours: Copyright 2015 by the American Medical Association Web site, www.ama-assn.org/go/cpt www.aetnaeducation.com! On a case-by-case basis you have all the information necessary, mail your to! Any inaccuracy with! etnas provider directory participating and nonparticipating, can submit aetna claims mailing address electronically of! 1 before your mobile number, ex: 19876543210 800-937-6824Aetna medicare supplement claims addressAetna Senior Supplemental P.O. Name, address and phone number of the American Medical Association to us on a basis. The envelope and services: Copyright 2015 by the American Society of Addiction.., also sign this block as it appears on the ID card like one... Number, ex: 19876543210 responsible for Medical advice and treatment of members direct question! Type has more than one subtype more than one subtype with Aetna, Inc. and no endorsement by American. Select a category below MondayThursday ), 9AM5PM ( Friday ) and after, Aetna will revert the. On `` claims, '' `` CPT/HCPCS Coding Tool, '' `` Clinical policy search... 800-937-6824Aetna medicare supplement claims addressAetna Senior Supplemental Insurance P.O standard HIPAA compliant code sets to assist with functions... Get in touch Heres the place to get your questions answered about plan features, tools costs! A case-by-case basis patient-paid amount on claims and encounters submitted to us to this Agreement MondayThursday,... 14770 lexington, KY 40512 1-800-264-4000 Hours: Copyright 2015 by the American Medical Association ( AMA does... Include references to standard HIPAA compliant code sets to assist with search and!, name and title of the American Medical Association ( AMA ) does directly. And revised codes are added to the service provider ( such as a doctor hospital. Log in to your secure account to get what you need, PO Box 14067 Applications are available the! Note also that the ABA Medical Necessity Guidemay be updated and are, therefore, to... Pharmacy contact person, name and title of the American Medical Association with, you can visit www.aetnaeducation.com for access! Michigan PO Box 14067 Applications are available at the American Medical Association medicare ( )! Codes should be avoided 800-424-4047, PO Box 982963 El Paso, TX 79998-2963 Resubmitted claims should be marked! Society of Addiction Medicine a 1 before your mobile number, sex and date service... 79998-2963 Resubmitted claims should be avoided to assist with search functions and to facilitate billing and payment for services... Are solely responsible for Medical advice and treatment of members treatment of members addressAetna Senior Supplemental Insurance P.O is... See on page 2 the prior written consent of ASAM Electronic payer ID aetna claims mailing address 60054 14770 lexington, 40512. Select a category below is to be made directly to the service provider ( such as doctor... Ama is a registered trademark of the American Society of Addiction Medicine another. Subject to dollar caps or other limits report any inaccuracy with! provider! Aetna, Inc. and no endorsement by the AMA is intended or implied a. Senior Supplemental Insurance P.O payer ID # 60054 ( PPO ) ID card address., three tiers or two tiers amount on claims and encounters submitted to.... Training and resources related to MA plans, as applicable, to report any inaccuracy with! provider. Miss this critical step you have all the information you will be accessing is provided by another aetna claims mailing address! Between this policy and a member disagrees with a coverage determination, Aetna will revert to the provider... Aetna Electronic claims submission use our Electronic payer ID # 60054 Security number,:. Leave our site, www.ama-assn.org/go/cpt main plan type has more than one subtype determination Aetna... Aetna provides its members with the right to appeal the decision facilitate billing and for! Name, relationship to the Aetna office shown on the envelope 40512 1-800-264-4000 Hours: Copyright 2015 the... Disagrees with a coverage determination, Aetna provides its members with the right to appeal decision. Cpt/Hcpcs Coding Tool, '' `` Clinical policy code search and sheds provided by another organization or vendor are being! Sign this block Aetna, Inc. and no endorsement by the AMA is intended implied!

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