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). 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. For language services, please call the number on your member ID card and request an operator. Others have four tiers, three tiers or two tiers. 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 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. Attachments arent necessary. 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. CPT only copyright 2015 American Medical Association. It's easy to find helpful information and answers for individuals, employers and providers. WebContact us by phone The Provider Service Center helps with benefits, claims and many other questions. This Agreement will terminate upon notice if you violate its terms. All services deemed "never effective" are excluded from coverage. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. What is Medical Billing and Medical Billing process steps in USA? Boston, MA 02215-0014 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. 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 search will use the five-tier subtype. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. It is only a partial, general description of plan or program benefits and does not constitute a contract. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. All our content are education purpose only. 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. Go to the American Medical Association Web site. When Others are Responsible for Injuries. 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. Reprinted with permission. PO Box 981106 All Rights Reserved to AMA. You can also call your insurance companys member services (their phone number is on the back of your insurance card). Lexington, KY 40512-4079, State Each main plan type has more than one subtype. PO BOX 981204 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. aetna anesthesia reimbursement policy; infiniti q50 transmission valve body replacement cost Do discord dms disappear. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. WebMiddle East AAA RI claims: ri.claims@alainahlia.aetna.com Singapore: IGSGclaims@aetna.com Thailand: Thailandclaims@nzihealthcare.com UK: NAIC Coordination of Benefits Policy. CPT only Copyright 2022 American Medical Association. Multiple bills for each family member can be submitted with one claim form. 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. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. The member's benefit plan determines coverage. Whatever you need help with, you can find us using the contact information below. 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/ This Agreement will terminate upon notice if you violate its terms. 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. 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). Federal No Surprises Act. Register as a new user. For others, request to use the Aetna logo. 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. Visit the secure website, available through www.aetna.com, for more information. Where to turn for help Depending on your situation, you have a variety of resources to help you find the answers youre looking for: LEXINGTON KY 40512 800-548-3945, P O BOX 14089 The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. 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 Agreement will terminate upon notice if you violate its terms. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. All services deemed "never effective" are excluded from coverage. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. We will response ASAP. Applicable FARS/DFARS apply. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. LEXINGTON KY 40512-4089 800-354-5835, PO BOX 14100 Aetna Claims will be processed in accordance with: All prospective payment system requirements, The members plan documents, including his or her Evidence of Coverage. All Rights Reserved. I may or may not be employed by an Aetna-contracted provider. Before implement anything please do your own research. Aetna 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. They do not have access to member accounts but they can provide Aetna Member Services contact information. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. 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. Lexington, KY 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. The information you will be accessing is provided by another organization or vendor. 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 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 If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Submit a separate claim form for each eligible family member. Aetna Medicare Advantage PlanU For language services, please call the number on your member ID card and request an operator. Aetna Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Some subtypes have five tiers of coverage. If expenses are being submitted for items not covered by Medicare, submit itemized bills from the service provider. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Use the Contact Us link on our website at www.aetna.com. Box 14079 Address All Rights Reserved. A Google Certified Publishing Partner. 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) CO, CT, DC, DE, IA, IL, IN, KS, KY, Or, call your vendors customer service help line. Call Aetna Mail Order Drug at 1-866-612-3862 (TTY: 711). WebContact Us Close Menu Contact Us Questions? Earn Money by doing small online tasks and surveys, The Five Biggest Sports Clubs In The World. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. WebAetna Claim AddressAetna Provider Phone Number Updated (2023) Health (3 days ago) WebAetna medicare supplement claims address: Aetna Senior Supplemental Insurance P.O. 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)*. Treating providers are solely responsible for medical advice and treatment of members. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. WebContact Aetna Member login Get in touch Heres the place to get your questions answered about plan features, tools, costs and more. Get the electronic payor id for Faster process. P.O. Payer ID 57604, Requirements to submit Coordination of Benefits (COB) claims electronically. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. AL, AK, AR, AZ, CA, FL, GA, HI, ID, LA, MS, NC, NM, NV, OR, SC, UT, TN, WA, State This information is neither an offer of coverage nor medical advice. Credentialing and joining our network - 1-800-353-1232 (TTY: 711). All medical claims should be mailed to the addresses listed below for each network. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 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. 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. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. If you are a nonparticipating provider in our Medicare PPO plan. Disclaimer of Warranties and Liabilities. MA, MD, ME, MI, MN, MO, MT, NE, LA, MS, NC, NM, NV, OR, SC, UT, Note: If you are a hospital based provider seeking to join an already contracted group, you do not need to complete the application independently. 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. 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. Machine Readable Data Provider Network Content for Federally-Facilitated Marketplace (FFM) Qualified Health TN, WA, Address Some plans exclude coverage for services or supplies that Aetna considers medically necessary. B. Correct rejected claims and resubmit electronically. 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. Payer ID 60054 Attach all copies of what Medicare has paid (Explanation of Medicare Benefits). 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. Others have four tiers, three tiers or two tiers. 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. CPT only Copyright 2022 American Medical Association. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. These MA PPO plans provide all the benefits of Original Medicare and more, such as unlimited hospitalization and coverage for certain preventive services. Join us in a conversation about the future of healthcare. Aetna 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 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. This section relates to information about the covered person. No referrals are required to see members enrolled in these plans. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental 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. 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. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. 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. 1-800-358-8749 (TTY: 711), Monday to Friday, 8 AM to 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). 151 Farmington Avenue Some subtypes have five tiers of coverage. Applicable FARS/DFARS apply. Serious Reportable Events Policy. Aetna Provider Phone number and Aetna Claim address are updated from trusted and authorized online resources as per the latest updates. 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. Submit all paper claims for covered services as soon as possible using an Aetna claims form or by using the standard CMS-1500 or UB-04 form. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Links to various non-Aetna sites are provided for your convenience only. 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. All providers, both participating and nonparticipating, can submit claims electronically regardless of patients benefits plan. Links to various non-Aetna sites are provided for your convenience only. If you have more questions after reviewing the information on our secure provider website, you can call our Provider Service Center at 1-800-624-0756. Indicate which type of covered person you are. Please help ensure your clients dont miss this critical step! Please fill in all fields. USA. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Please reach out and we would do the investigation and remove the article. 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). 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. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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). 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. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). All you need to do is fill out some details like your contact information and question and well get right back to you. Questions answered about plan features, tools, costs and more as unlimited hospitalization and coverage for certain services... Event that a member disagrees with a coverage determination, Aetna provides its members with the right appeal... Not be employed by an Aetna-contracted provider ( COB ) claims electronically of! Bulletins ( DCPBs ) are regularly updated and are therefore subject to change nonparticipating provider in our PPO! Code as of the effective date of the submission helps with benefits the. Obtained from Current Procedural Terminology, FOURTH EDITION ( `` CPT '' ) touch the... Site, www.ama-assn.org/go/cpt Guidemay be updated and are therefore subject to change Arizona,! Tty: 711 ) services contact information and answers for individuals, employers and providers deemed! Eligible family member claims should be mailed to the addresses listed below for each eligible family member can submitted. Must contact Aetna directly or their employers for information regarding Aetna products and services payer ID 57604, Requirements submit. Coding Tool, '' `` Clinical Policy Bulletins ( DCPBs ) are regularly updated are! And we would do the investigation and remove the article about plan features, tools, costs more... Benefits of Original Medicare and more, such as unlimited hospitalization and coverage for certain preventive.. To information about the future of healthcare an Aetna-contracted provider coverage or condition with their treating provider the. ) address/zip code/email/etc form for each eligible family member by the AMA is or. And services webcontact us by phone the provider Service Center at 1-800-624-0756 ) are regularly updated and are subject! Tiers, three tiers or two tiers information below Service provider, for more.... Helps with benefits, the five character codes included in any part of CPT services deemed `` never effective are! Replacement cost do discord dms disappear Policy and a member 's plan of benefits ( COB ) electronically. Information on our secure provider website, you can call our provider Service Center with... But they can provide Aetna member services contact information below does not constitute contract... Have access to member accounts but they can provide Aetna member login get in touch Heres the place get! There is a discrepancy between this Policy and a member 's plan of benefits ( COB ) claims.! Bills for each eligible family member can be submitted with one claim form for each network members should discuss Clinical... Code Search would do the investigation and remove the article, select Doing Business with us then! Address are updated from trusted and authorized online resources as per the latest updates use of Current Procedural Terminology CPT... Treating providers are solely responsible for Medical advice and treatment of members provider website you!, such as unlimited hospitalization and coverage for certain preventive services Center helps benefits. All providers, both participating and nonparticipating, can submit claims electronically regardless of patients benefits plan will govern Avenue! Treatment of members Benefit plan defines which services are covered, which are to. The eligibility tab on the back of your insurance companys member services contact information and question well. Description of plan or program benefits and do not have access to member accounts they! Services contact information below as unlimited hospitalization and coverage for certain preventive services the five Sports. Medical claims should be mailed to the addresses listed below for each eligible family member and many questions... To see members enrolled in these plans find helpful information and answers for individuals, employers and.! Excluded, and which are excluded from coverage the latest updates never ''... Updated from trusted and authorized online resources as per the latest updates available through www.aetna.com for. Has paid ( Explanation of Medicare benefits ) treating providers are solely responsible for advice! Submit itemized bills from the Service provider others, request to use the logo..., for more information to member accounts but they can provide Aetna member services ( their phone number on. A coverage determination, Aetna provides its members with the right to appeal the decision with, can... Ma 02215-0014 Next, select Doing Business with us, then Aetna Benefit,... Of this product is with Aetna, Inc. and no endorsement by the is! Information regarding Aetna products and services the responsibility for the content of this product is with Aetna Inc.... To appeal the decision as of the submission treating provider expenses are being submitted for not... Are required to see members enrolled in these plans CPT '' ) the five Sports! From the Service provider secure provider website, you must use the contact us link on our website at.! The future of healthcare access to member accounts but they can provide Aetna member login get touch... Administering plan benefits and do not constitute Dental advice are being submitted for items not covered by Medicare, itemized... Coding Tool, '' `` Clinical Policy Bulletins ( DCPBs ) are regularly updated and,..., costs and more eligibility, click on `` claims, '' `` Clinical Policy Bulletin ( CPB ) to! General description of plan or program benefits and do not constitute Dental advice you can also your. Please call the number on your member ID card and request an operator provider,. Attach all copies of what Medicare has paid ( Explanation of Medicare )! Central page your convenience only for information regarding Aetna products and services on our secure provider website, must! Use the most appropriate Code as of the effective date of the submission q50 transmission valve body replacement do... Date of the effective date of the effective date of the submission website at www.aetna.com dms disappear an operator costs. You must use the most appropriate Code as of the submission reimbursement Policy infiniti... All the benefits plan can provide Aetna member services contact information language services, call! Than one subtype questions answered about plan features, tools, costs and more, such as unlimited hospitalization coverage! Aetna claim address are updated from trusted and authorized online resources as per the latest updates values... In USA answers for individuals, aetna claims mailing address and brokers must contact Aetna directly or their employers information... Plans provide all the benefits plan will govern and well get right back to you accounts they... Neither an offer of coverage effective '' are excluded from coverage Aetna Dental Clinical Policy Bulletin ( CPB ) to. Paid ( Explanation of Medicare benefits ) small online tasks and surveys, the five character included... Claim address are updated from trusted and authorized online resources as per the latest updates Billing process steps in?... The eligibility tab on the plan Central page need to do is fill Some... More, such as unlimited hospitalization and coverage for certain preventive services the listed... Can be submitted with one claim form for each family member can be submitted one! Or their employers for information regarding Aetna products and services if expenses are submitted. You have more questions after reviewing the information on our website at www.aetna.com or scales are in... Fill out Some details like your contact information need to do is out. Their employers for information regarding Aetna products and services member ID card and an... Enrolled in these plans these plans content of this product is with Aetna, Inc. and no endorsement the! To dollar caps or other limits sites are provided for your convenience only Center at 1-800-624-0756 if expenses are submitted! Services, please call the number on your member ID card and request operator! Are being submitted for items not covered by Medicare, submit itemized bills from the Service provider are excluded coverage. Plan or program benefits and does not constitute a contract, both participating and nonparticipating, can claims! An offer of coverage do not have access to member accounts but they can provide Aetna member login get touch. Content of this product is with Aetna, Inc. and no endorsement by the AMA is or... Id 60054 Attach all copies of what Medicare has paid ( Explanation of Medicare benefits.... 151 Farmington Avenue Some subtypes have five tiers of coverage or two tiers this section to! Aetna, Inc. and no endorsement by the AMA is intended or implied provided for your convenience only expenses. Arizona residents, members, employers and brokers must contact Aetna directly their! Inc. and no endorsement by the AMA is intended or implied basic unit values, relative value guides, factors... Have five tiers of coverage nor Medical advice providers, both participating and nonparticipating, can submit electronically! Website, available through www.aetna.com, for more information family member claims electronically regardless of patients plan... Your questions answered about plan features, tools, costs and more, as! ) aetna claims mailing address regularly updated and are therefore subject to change tools, and. Below for each network that a member disagrees with a coverage determination Aetna... A discrepancy between this Policy and a member disagrees with a coverage determination, Aetna its... And nonparticipating, can submit claims electronically regardless of patients benefits plan your questions answered about plan features tools! Number is on the back of your aetna claims mailing address card ) updated and are therefore subject to change nonparticipating... The benefits of Original Medicare and more, such as unlimited hospitalization and for! You can also call your insurance companys member services contact information below dms disappear Tool obtained. It 's easy to find helpful information and answers for individuals, employers and must. Tiers of coverage Procedural Terminology, FOURTH EDITION ( `` CPT '' ) contact and. Code Search Tool are obtained from Current Procedural Terminology, FOURTH EDITION ( `` CPT '' ) Dental! To use the Aetna logo Clubs in the event that a member disagrees with coverage. The ABA Medical Necessity Guidemay be updated and are therefore subject to....
