NAIC Coordination of Benefits Policy. New and revised codes are added to the CPBs as they are updated. Aetna Some plans exclude coverage for services or supplies that Aetna considers medically necessary. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. LEXINGTON, KY 40512-4586, Attachment Mailing Address PO Box 981106 Our MA PPO plan members can obtain covered services from participating providers or from nonparticipating providers who are eligible to receive payment from Medicare and are willing to accept the plan. 79998-1106, Aetna Student HealthSM Aetna has more address but usually accept all the claims whatever address you submit from the below list. Unlisted, unspecified and nonspecific codes should be avoided. Whatever you need help with, you can find us using the contact information below. Independent non-retail pharmacies - such as long-term care facilities, home infusion pharmacies, and mail order pharmacies - can call one of the phone numbers below to request participation: Chain or Pharmacy Services Administrative Organization (PSAO) pharmacies. Earn Money by doing small online tasks and surveys, The Five Biggest Sports Clubs In The World. Mail to: We want to make it easier for you to live healthier. WebEmailing us Faxing us at 1-844-209-2060 EFT form (PDF) Youll want to allow up to 15 days for us to process your EFT form. Correct rejected claims and resubmit electronically. Treating providers are solely responsible for dental advice and treatment of members. Electronic claims submission Use our electronic payer ID #60054. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. All medical claims should be mailed to the addresses listed below for each network. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Avoid the additional cost of submitting duplicate claims by using the Claim Status Inquiry to check the status of claims prior to resubmitting. The Provider Service Center helps with benefits, claims and many other questions. Submit all paper claims for covered services as soon as possible using an Aetna CPT only copyright 2015 American Medical Association. New and revised codes are added to the CPBs as they are updated. 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) Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. 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. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. #60054 would be the payor id for most of the clearing house however double confirm the same with your clearing house. You have options. Aetna If you do not intend to leave our site, close this message. 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). ICD 10 code for Arthritis |Arthritis Symptoms (2023), ICD 10 Code for Dehydration |ICD Codes Dehydration, ICD 10 code Anemia |Diagnosis code for Anemia (2023). When billing, you must use the most appropriate code as of the effective date of the submission. 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. PO Box 981106 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. ID card Medicare PPO is indicated in the upper corner of the ID card (see the example on page 2). Disclaimer of Warranties and Liabilities. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Payer ID 60054 If you missed Open Enrollment, While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Federal No Surprises Act. PO Box 14079 The ABA Medical Necessity Guidedoes not constitute medical advice. 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. For your convenience, we recommend that you add your Member Services number to your phone contacts. In case of a conflict between your plan documents and this information, the plan documents will govern. 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. Aetna Medicare Grievance & Appeals Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. You may file a written grievance within 60 days after the date of the event out of which the grievance occurred. 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. Treating providers are solely responsible for medical advice and treatment of members. Well need to terminate your existing agreement with us. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. Lexington, KY 40512-4079, State In all cases, the patient or authorized person must sign. It is only a partial, general description of plan or program benefits and does not constitute a contract. 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. For all other Products Provider Dispute Inquiries (PPO and Commercial HMO plans): Contact the Provider Service Center at 1-888-MD-Aetna (632-3862). 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 members can attend a local seminar to understand how to get the most from their plans. This is the phone number For others, request to use the Aetna logo. El Paso, TX 79998-1106. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The AMA is a third party beneficiary to this Agreement. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Treating providers are solely responsible for medical advice and treatment of members. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. For claims that have completed the payment process, you may retrieve supplemental claims information, such as copayment or coinsurance amounts or negotiated fee adjustments, using the financial status transaction. The member's benefit plan determines coverage. CPT is a registered trademark of the American Medical Association. But for those enrolling in an HMO plan, this is especially important. Applicable FARS/DFARS apply. 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). Visit the secure website, available through www.aetna.com, for more information. 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. 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. WebForms and Resources. 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. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. All Rights Reserved to AMA. Reprinted with permission. No fee schedules, basic unit, relative values or related listings are included in CPT. When billing, you must use the most appropriate code as of the effective date of the submission. A complete application is the first step in the enrollment process When assisting your clients with their application, youre responsible for answering their questions and ensuring all required information on the enrollment form is complete. More online tools and resources available at www.aetna.com, For more information about Aetna Medicare plans, log in to our secure provider website, available through www.aetna.com. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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. USA. For questions on how to submit electronic claims to third-party administrators, such as an individual practice association, contact the third-party administrator. The member's benefit plan determines coverage. If payment is to be made DIRECTLY to the service provider (such as a doctor or hospital), also sign this block. Members, employers and brokers must contact Aetna directly or their employers for information regarding products. Contact the third-party administrator as they are updated as a doctor or )! 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