This information is neither an offer of coverage nor medical advice. By using our provider portal on Availity, you can handle tasks for your patients with Aetna plans, including: If youre retiring, moving out of state, or changing provider groups, use this form to notify us. Dont have an account? The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. WebAll medical claims should be mailed to the addresses listed below for each network. 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. This section relates to information about the covered person. Aetna Medicare Advantage PlanU MIAMI FL 33256 800-452-8633, P O BOX 14079 If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Links to various non-Aetna sites are provided for your convenience only. Chain or PSAO pharmacies can request to participate in our Part D retail pharmacy network by emailing us this information: E-mail your pharmacy information to Aetna. All services deemed "never effective" are excluded from coverage. Learn more about Ezoic here. If you are an Aetna member with questions about your coverage, please refer to our Member Services page for login information and additional ways to contact us. Treating providers are solely responsible for dental advice and treatment of members. The member's benefit plan determines coverage. CPT is a registered trademark of the American Medical Association. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). No referrals are required to see members enrolled in these plans. 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. Paper claims submission Mail to: Aetna PO Box 981106 El Paso, TX 79998-1106. The member's benefit plan determines coverage. Lexington, KY If your practice management system requires you to enter a billing address, use the address listed below for the state in which you practice: State If necessary, use the following claims billing addresses. The AMA is a third party beneficiary to this Agreement. 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. 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. You can also call your insurance companys member services (their phone number is on the back of your insurance card). Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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. CPT is a registered trademark of the American Medical Association. 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. 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. 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. Note: If you are a hospital based provider seeking to join an already contracted group, you do not need to complete the application independently. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. CPT only copyright 2015 American Medical Association. 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. Links to various non-Aetna sites are provided for your convenience only. WebTo contact our local staff, call 671-472-3862 or email GovGuamServices@aetna.com from 8AM5PM (MondayThursday), 9AM5PM (Friday). 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. If you missed Open Enrollment, please contact your HR representative immediately. 40512-4079, State Do you want to continue? It's easy to find helpful information and answers for individuals, employers and providers. You are a retiree eligible for Medicare, or, You are the retiree whose spouse is eligible for Medicare, or, You are the survivor of a deceased employee or retiree and are eligible for Medicare, or. 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. 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. PO BOX 981204 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)*. Lexington, KY 40512-4079, State Reimbursement and claims processing information. If you do not intend to leave our site, close this message. B. Payer ID 60054 Mail the claim to Meritain Healths claims address listed on the members ID card. Please log in to your secure account to get what you need. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Precertification is recommended, but not required. All services deemed "never effective" are excluded from coverage. 860 262 9111. This search will use the five-tier subtype. Just log in to your member account to send us an email or chat online. Well need to terminate your existing agreement with us. Join us in a conversation about the future of healthcare. 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. Email, call or chat with Availity users log in to send us your questions, Submit a medical or behavioral health question or comment, Submit a National Provider Identifier (NPI), Submit a National Provider Identifier (NPI) exemption, Request clinical review criteria for New York state residents. 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. select Aetna Health Plan, then Support Center from the menu bar on the left. PO Box 398106. Links to various non-Aetna sites are provided for your convenience only. ND, NH, NJ, NY, OH, OK, PA, RI, SD, Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. For your convenience, we recommend that you add your Member Services number to your phone contacts. 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). 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Links to various non-Aetna sites are provided for your convenience only. AETNA Payer ID 60054, PO BOX 569000 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. 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. Some subtypes have five tiers of coverage. WebYou can talk to Aetna Medicaid Administrators by calling: 602-659-1100 (TTY: 711) Hours: MF, 9 AM5 PM MT By mail You can mail us a letter at: Aetna Medicaid Administrators 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. 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 the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Amerihealth Caritas Directory Healthcare, Health Insurance in United States of America, Place of Service Codes List Medical Billing. 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. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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. 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. 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. Aetna Member Services Aetna Address for Member Services; Corporate Headquarters: 151 Farmington Avenue Hartford, CT 06156: Aetna addresses for 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. Provider termination form and directory update. 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. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. El Paso, TX The revenue codes and UB-04 codes are the IP of the American Hospital Association. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. You are now being directed to CVS Caremark site. Lexington, KY 40512-4079 Enter the member ID number exactly as it appears on the ID card. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. The AMA is a third party beneficiary to this Agreement. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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 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. Find a seminar Extra benefits From a 24-hour nurse line to vision and To help us direct your question or comment to the correct area, please select from oneof the categories below. Phone: 800 264.4000. To help us direct your question or comment to the correct area, please select a category below. 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. 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. Thanks, Coupon "NSingh10" for 10% Off onFind-A-CodePlans. PO Box 15708 LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. All Rights Reserved. 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. This is the phone number for the Corporate Contact Center. 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. You are now being directed to the CVS Health site. Box 10462 Van Nuys, CA 91410 Want to become a participating dentist? If youre moving or changing jobs, you can sign a new agreement for your new practice or location. Each main plan type has more than one subtype. Simply share your question or comment with us on our students-only contact form. 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). All providers, both participating and nonparticipating, can submit claims electronically regardless of patients benefits plan. 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 CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). For Medicare Products Provider Dispute Inquiries HMO plans only: Contact the Provider Service Center at 1-800-624-0756. When billing, you must use the most appropriate code as of the effective date of the submission. When you have all the information necessary, mail your claim to the Aetna office shown on the top of this form. 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. Applicable FARS/DFARS apply. USA. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Copyright 2015 by the American Society of Addiction Medicine. They do not have access to member accounts but they can provide Aetna Member Services contact information. TX, VA, VT, WI, WV, WY 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. PO Box 981106 Submit all paper claims for covered services as soon as possible using an Aetna 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. Provide the name, Member ID number or Social Security number, address and phone number of the covered person. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. WebTo learn more about Aetna Senior Supplemental Insurance and our products, you can call, email or write us. For Medicare HMO plans only: 1-800-624-0756; For all other plans (PPO and Commercial HMO plans): 1-888 MD-Aetna (632-3862); Or visit the Aetna website at www.aetna.com. Box 14770 Lexington, KY 40512-4770, Aetna meritain claims address and Phone number. Fir plywood Marine A/B 3/4" x 48" x 96". 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. We are expecting an increase in membership for our Medicare Advantage (MA) preferred provider organizations (PPOs). 1. 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. All Rights Reserved. PO Box 14020 Some plans exclude coverage for services or supplies that Aetna considers medically necessary. We have been serving the construction and building industry since 1961. 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. Mail to: Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". In case of a conflict between your plan documents and this information, the plan documents will govern. 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 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. 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. This information is neither an offer of coverage nor medical advice. 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. 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). CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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 Claim Address & Phone No. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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.
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