The AMA is a third party beneficiary to this Agreement. Find a seminar Extra benefits From a 24-hour nurse line to vision and Call Aetna Mail Order Drug at 1-866-612-3862 (TTY: 711). All dental claims should be mailed to GEHA at the appropriate address below: Direct Care Broker or Supplier Contracts EDI Submitter: 44054 P.O. PO Box 981106 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). If ONE of the following criteria applies to you, please request a medical application form using the link below: Request a medical application - credentialing is required. Medical Billing and Coding Information Guide. You are now being directed to the CVS Health site. If youre moving or changing jobs, you can sign a new agreement for your new practice or location. 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. Aetna Attach all copies of what Medicare has paid (Explanation of Medicare Benefits). Learn more about Ezoic here. All services deemed "never effective" are excluded from coverage. We're here to help. The ABA Medical Necessity Guidedoes not constitute medical advice. 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. If you feel some of our contents are misused please mail us at medicalbilling4u at gmail dot com. 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. 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. #60054 would be the payor id for most of the clearing house however double confirm the same with your clearing house. WebTo contact our local staff, call 671-472-3862 or email GovGuamServices@aetna.com from 8AM5PM (MondayThursday), 9AM5PM (Friday). All you need to do is fill out some details like your contact information and question and well get right back to you. Links to various non-Aetna sites are provided for your convenience only. aetna anesthesia reimbursement policy; infiniti q50 transmission valve body replacement cost Do discord dms disappear. Thanks, Coupon "NSingh10" for 10% Off onFind-A-CodePlans. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Simplified billing submit one bill to Aetna and receive one remittance. 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. PO Box 14020 Treating providers are solely responsible for medical advice and treatment of members. All services deemed "never effective" are excluded from coverage. 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 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. MIAMI FL 33256 800-452-8633, P O BOX 14079 CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). Remember to include the patient-paid amount on claims and encounters submitted to us. All Rights Reserved. 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. 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. Medicare medical and dental plans - 1-800-624-0756 (TTY: 711) Non Once logged in, under Plan Central,. The member's benefit plan determines coverage. All services deemed "never effective" are excluded from coverage. CO, CT, DC, DE, IA, IL, IN, KS, KY, Aetna Medicare Grievance & Appeals Do you want to continue? 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 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. Well contact you if we need additional documentation. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Others have four tiers, three tiers or two tiers. If payment is to be made DIRECTLY to the service provider (such as a doctor or hospital), also sign this block. Your benefits plan determines coverage. Applicable FARS/DFARS apply. Tampa Florida 33630 Machine Readable Data Provider Network Content for Federally-Facilitated Marketplace (FFM) Qualified Health Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. This information is neither an offer of coverage nor medical advice. When billing, you must use the most appropriate code as of the effective date of the submission. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. If you have any questions, please contact our Provider Service Center at the following: If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Box 14079 WebOn AVA, youll need: Provider billing tax identification number (TIN) or NPI Patient ID or subscribers Social Security number Patient date of birth Date of service range Provider fax number (if a fax back is needed) For inquiries submitted online, please provide: Provider billing tax identification number (TIN) and NPI 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. Each main plan type has more than one subtype. 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. Insurance at 1-800-927-4357, as applicable, to report any inaccuracy with !etnas provider directory. WebContact Us Close Menu Contact Us Questions? EL PASO TX 79998 800-223-3580. 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. PO Box 398106. 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). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Aetna HMO 800-624-0756, PO BOX 30545 Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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. No referrals are required to see members enrolled in these plans. Lexington, KY 40512, P O BOX 981109 EL PASO TX 79998-1109 800-777-3240, PO BOX 981107 EL PASO TX 79998-1107 800-245-1206, Aetna B,M ,W 888-632-3862 Claims will be processed in accordance with: All prospective payment system requirements, The members plan documents, including his or her Evidence 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. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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. 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". Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. We are expecting an increase in membership for our Medicare Advantage (MA) preferred provider organizations (PPOs). 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). Applicable FARS/DFARS apply. 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. Just log in to your member account to send us an email or chat online. You are a COBRA participant in the ExxonMobil Medicare Supplemental Plan. Unlisted, unspecified and nonspecific codes should be avoided. 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. 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 responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. New and revised codes are added to the CPBs as they are updated. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. PO Box 14067 What is Medical Billing and Medical Billing process steps in USA? This is the phone number Heres the place to get your questions answered about plan features, tools, costs and more. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 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. Designed by Elegant Themes | Powered by WordPress. If you do not intend to leave our site, close this message. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. 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. 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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Since Dental Clinical Policy Bulletins (DCPBs) 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. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. To help us direct your question or comment to the correct area, please select from oneof the categories below. 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. Some subtypes have five tiers of coverage. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. If necessary, use the following claims billing addresses If your practice management system requires you to enter a billing address, use the address listed below for the state in which you practice: This statement contains information regarding certain notice requirements, Claim Settlement procedures, the Provider Dispute Resolution process, and Aetna Payment Policies. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Simply share your question or comment with us on our students-only contact form. 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. Biometric Screenings. Please be sure to add a 1 before your mobile number, ex: 19876543210. You can also call us at the number on your ID card for personal service. Since Dental Clinical Policy Bulletins (DCPBs) 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. The member's benefit plan determines coverage. 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. Submit a separate claim form for each eligible family member. With respect to bundling/unbundling logic, we use the Correct Coding Initiative (NCCI). 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. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Aetna Medicare Grivance submission address. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. The revenue codes and UB-04 codes are the IP of the American Hospital Association. A grievance is a type of complaint you make about us or one of our network providers or pharmacies, including a complaint concerning the quality of your care. When billing, you must use the most appropriate code as of the effective date of the submission. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. This helps ensure the right PCP is assigned to the members file. CPT 81479 oninvasive Prenatal Testing for Fetal Aneuploidies, CPT CODE 47562, 47563, 47564 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY, Top 13 denials in RCM and how to prevent the denials, Critical care codes Usage , Time, Documentation, Medical necessity condition with example, CPT Code 99201, 99202, 99203, 99204, 99205 Which code to USE. Make sure the following items are included on all applications: Beneficiarys name, as shown on their Medicare card, Beneficiarys permanent residence address/physical street address (PO box is not acceptable), Medicare HICN this is the number on the beneficiarys Medicare card, Proof of Medicare Part A and/or B entitlement, On all 2018 applications, your National Producer Number (NPN)*. 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 addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Unlisted, unspecified and nonspecific codes should be avoided. Unlisted, unspecified and nonspecific codes should be avoided. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 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. Members should discuss any matters related to their coverage or condition with their treating provider. BOX 14586 Aetna countered that statistic with its own, which says that 98% of Blue Cross NCs 2021 claims came from providers in Aetnas network. In case of a conflict between your plan documents and this information, the plan documents will govern. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Lexington, KY 40512-4079 The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. All the contents and articles are based on our search and taken from various resources and our knowledge in Medical billing. 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. Special notice for providers not accepting new patients: What to do if youre contacted by a member or potential member If youre not accepting new patients, but are contacted by a member or a potential member who wants to become a new patient, you must tell them to contact: ** The California Department of Managed Health Care at 1-888-466-2219, or the California Department of. Medical Billing Question and Answer Terms, EVALUATION AND MANAGEMENT CPT code [99201-99499] Full List, Internal Medical Billing Audit how to do. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. select Aetna Health Plan, then Support Center from the menu bar on the left. 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. Health Savings Account Tools and Information. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Before implement anything please do your own research. El Paso, TX 79998-1106. All the information are educational purpose only and we are not guarantee of accuracy of information. Note: If you are a hospital based provider seeking to join an already contracted group, you do not need to complete the application independently. All Rights Reserved to AMA. Disclaimer of Warranties and Liabilities. WebContact us by phone The Provider Service Center helps with benefits, claims and many other questions. 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. The ABA Medical Necessity Guidedoes not constitute medical advice. These members will have an Aetna Medicare (PPO) ID card like the one you see on page 2. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. Reprinted with permission. Boston, MA 02215-0014 Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 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. 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. Avoid the additional cost of submitting duplicate claims by using the Claim Status Inquiry to check the status of claims prior to resubmitting. 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. 1-855-335-1407 (TTY: 711), 7 days a week, 8 AM to 8 PM. Disclaimer of Warranties and Liabilities. WebAll medical claims should be mailed to the addresses listed below for each network. The information you will be accessing is provided by another organization or vendor. Attachments arent necessary. No fee schedules, basic unit, relative values or related listings are included in CPT. 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).
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