Reprinted with permission. Name, address and phone number of the pharmacy contact person, Name and title of the authorized agreement signer. New and revised codes are added to the CPBs as they are updated. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. In case of a conflict between your plan documents and this information, the plan documents will govern. 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. All Rights Reserved. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. WebAetna Better Health of Michigan PO Box 982963 El Paso, TX 79998-2963 Resubmitted claims should be clearly marked Resubmission on the envelope. A Google Certified Publishing Partner. Where to turn for help Depending on your situation, you have a variety of resources to help you find the answers youre looking for: License to sue 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. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. The member's benefit plan determines coverage. Treating providers are solely responsible for medical advice and treatment of members. 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. The member's benefit plan determines coverage. 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. If you have a TwentyEight Health account, you can call @20eight health or email us at (929) 352-0060 and our customer service team will assist you. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. This type of complaint does not involve coverage or payment determinations. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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. Aetna Medicare Grivance submission address. WebMail Claims to: Aetna Pharmacy Management. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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. 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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. This section relates to information about the patient. Links to various non-Aetna sites are provided for your convenience only. 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. CPT is a registered trademark of the American Medical Association. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. PO Box 15708 WebIf youd like to mail your Medicare correspondence, please use this address: Aetna Senior Supplemental Insurance P.O. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. All dental claims should be mailed to GEHA at the appropriate address below: Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Lexington, KY 40512 Provide the patients name, relationship to the covered person, Member ID number or Social Security number, sex and date of birth. Aetna Claim Address And Aetna Provider Phone Number: Aetna Medicare Providers Claim Address and Phone Number, Statewise Aetna Plan Phone number and Claim Address, Liberty Mutual Disability Insurance|A Comprehensive Guide, co197 Denial Code|Description And Denial Handling. Register as a new user. 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. Members should discuss any matters related to their coverage or condition with their treating provider. In all cases, the patient or authorized person must sign. Aetna address and Aetna Provider Phone Number for Claims Complete list: Denials with solutions in Medical Billing, Denials Management Causes of denials and solution in medical billing, CO 4 Denial Code The procedure code is inconsistent with the modifier used or a required modifier is missing, CO 5 Denial Code The Procedure code/Bill Type is inconsistent with the Place of Service, CO 6 Denial Code The Procedure/revenue code is inconsistent with the patients age, CO 7 Denial Code The Procedure/revenue code is inconsistent with the patients gender, CO 15 Denial Code The authorization number is missing, invalid, or does not apply to the billed services or provider, CO 17 Denial Code Requested information was not provided or was insufficient/incomplete, CO 19 Denial Code This is a work-related injury/illness and thus the liability of the Workers Compensation Carrier, CO 23 Denial Code The impact of prior payer(s) adjudication including payments and/or adjustments, CO 31 Denial Code- Patient cannot be identified as our insured, CO 119 Denial Code Benefit maximum for this time period or occurrence has been reached or exhausted, Molina Healthcare Phone Number claims address of Medicare and Medicaid, Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit, Kaiser Permanente Phone Number Claims address and Timely Filing Limit, Amerihealth Caritas Phone Number, Payer ID and Claim address, ICD 10 Code for Sepsis Severe Sepsis and Septic shock with examples, Anthem Blue Cross Blue Shield Timely filing limit BCBS TFL List, Workers Compensation Insurances List of United States, Workers Compensation time limit for filing Claim and reporting in United States. LEXINGTON, KY 40512-4586, Attachment Mailing Address PO Box 981106 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. Aetna Inc. It's easy to update a provider address, phone number, fax number, email address or initiate an out-of-state move or a change in provider group. 1-800-358-8749 (TTY: 711), Monday to Friday, 8 AM to While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. When billing, you must use the most appropriate code as of the effective date of the submission. 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. Well need to terminate your existing agreement with us. All providers, both participating and nonparticipating, can submit claims electronically regardless of patients benefits plan. 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. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. A. Others have four tiers, three tiers or two tiers. License to sue 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 countered that statistic with its own, which says that 98% of Blue Cross NCs 2021 claims came from providers in Aetnas network. Links to various non-Aetna sites are provided for your convenience only. 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 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. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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). Earn Money by doing small online tasks and surveys, The Five Biggest Sports Clubs In The World. If youre moving or changing jobs, you can sign a new agreement for your new practice or location. Reimbursement and claims processing information. Payer ID 60054, PO BOX 569000 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. PO Box 981106 All Rights Reserved. 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. 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). 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. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". El Paso, TX Lexington, KY Electronic claims submission Use our electronic payer ID #60054. 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. Once logged in, under Plan Central,. Each main plan type has more than one subtype. Medical Billing and Coding Information Guide. The American medical Association a discrepancy between this Policy and a member plan. Dcpbs ) are regularly updated and are therefore subject to change date of authorized. Of complaint does not involve coverage or condition with their treating provider,... To standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered.. Hipaa compliant code sets to assist in administering plan benefits and do not constitute advice... Providers, both participating and nonparticipating, can submit claims electronically regardless of patients benefits plan products... 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