Aclaim can be resubmitted throughWebConnector by mail. You can reach us at: 1-855-620-3924 (TTY: 711) 24 hours a day, 7 days a week. Box 14094 Lexington, KY 40512-4094 . All Rights Reserved. The cost of ADR will be shared equally by the Company and the Provider. All services deemed "never effective" are excluded from coverage. Lexington KY. The decision of the arbitrator shall be non-binding unless both parties agree otherwise. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Contact Us | Allina Health Aetna It looks like your browser does not have JavaScript enabled. Aetna Better Health of Kentucky has moved to EERS. 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. To speak to someone about your Allina Health | Aetna coverage, you can call the Member Services phone number on your member ID card. 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). Suggestions or Complaints. *ClaimConnect is a registered trademeark of EHG (EDI Health Group, Inc.) and its subsidiaries. Policy/Group Number 3 . Following our guidelines will speed up claim determinations. 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. Links to ClaimConnect and its content are provided for your convenience. For inquiries submitted online, please provide: You will not see the status of rejected claims if the provider cant be identified on the rejected claim. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Learn about the timeframe for appeals and reconsiderations. This information is neither an offer of coverage nor medical advice. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Aetna Claims Address for Mailing and Insurance Phone Numbers for Aetna Voice Advantage may not be available for all claims/programs. Box 10462 Van Nuys, CA 91410 Once all necessary information is received, Aetna will re-evaluate the determination. A dentist may dispute a clinical denial on a members behalf with written authorization by the member. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Contact us. You can get an EFT form here or on our Provider Portal. We work to streamline the way we process claims. See claim instructions for AVALog in or registerSee a list of electronic transaction vendors. The Dentists will be notified of Aetnas determination of the appeal in writing within 60 calendar days of Aetnas receipt of the appeal. PO Box 981106 : El Paso, TX 79998-1106 . Send email to HMO billing and account reconciliation. Overview Aetna, Inc. offers insurance services. A summary of the ADR mechanism is below: o Provider shall notify the Company in writing at Aetna-Provider Resolution Team, PO Box 14597, Lexington KY 40512 or via fax at 859-455-8650 or at the address specified in the appeal response letter, within 60 days from receipt of the appeal response letter. Whats the procedure for disputing a claim decision. Aetna Inc. and itsaffiliated 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. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The member information you have may differ from what is in our eligibility file. To check the status of your claims, go to Aetna's website, Aetna Inc. and its affiliated 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. Aetna Inc. and its subsidiary companies assume no responsibility for any circumstances arising out of the use, misuse, interpretation or application of any information or other material provided by EDI Health Group (EHG). Call HMO billing and account reconciliation at 1-877-232-1621 (TTY: 711). Once processing is complete, well send you a confirmation letter. If you dont want to leaveyourstatesite, choose the X in the upper right corner to close this message. What should I do? If you do not intend to leave our site, close this message. Find forms for claims, payment, billing. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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). Lexington, KY 40512-4079, Precertification You can use payer ID L0140 to submit vision claims electronically through one of these options: Log in or register to your Provider Portal. You are now being directed to CVS Caremark site. Box 14597 Lexington, KY 40512-4597 Or fax to: 1-877-867-8729 Use this box for California grievances and appeals: Aetna Dental P.O. Lexington, KY 40512-4079. Submit your attachments, such as X-rays, electronically using FastAttach byNational Electronic Attachment(NEA). Aetna, please email us at AllinaAetna@media-minefield.com. Aetna Inc. and its subsidiary companies assume no responsibility for any circumstances arising out of the use, misuse, interpretation or application of any information or other material provided by EDI Health Group (EHG). Milwaukee, WI 53201. 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. Ithas infofor health care providers. www.aetna.com, and click on Search all claims. Applicable FARS/DFARS apply. Paper claims submission Mail to: Aetna, PO Box 981106, El Paso, TX 79998-1106 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 Member Services - HMO In-network doctors usually file claims for you. Do you want to continue? Lexington, KY 40512-4094 : 859-455-8650 . Call Aetna Member Services at 888-266-5519 (medical) or 877-238-6200 (dental) and discuss with them. 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. Visit the secure website, available through www.aetna.com, for more information. In case of a conflict between your plan documents and this information, the plan documents will govern. Contact Us - aetnaseniorproducts.com Treating providers are solely responsible for dental advice and treatment of members. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Office Ally: Use payer ID 128KS. To register, visit the Office Ally portal and follow the prompts. Aetna Better Health of Kansas No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. If the decision upholds Aetnas original position, dentists will receive a letter that includes. This link will take you to the main Aetna Medicaid website (AetnaBetterHealth.com). Insurance Claim Addresses and Phone Numbers (Starting with A) Or choose Go on to move forward to Aetna.com. Call for closest Eye Care Provider at 1-800-793-8616 (TTY: 711) 9 AM to 9 PM ET Monday through Friday and 9 AM to 5 PM ET Saturday. 1-800-638-8432 (TTY: 711) Option 1, Suggestions or Complaints The ABA Medical Necessity Guidedoes not constitute medical advice. The Aetna Grievance and Appeals Unit also has one box for all states except California, which has a separate box. Registration Guide: - [ Link] Toll-Free Number: 1-855-924-3368 # (1-855-WBG-DENT) Cigna Dental Postal Address for Claims Reimbursements: Cigna Dental P.O. Call PPO billing and account reconciliation at 1-800-297-7145 (TTY: 711). 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. Those should show if a claim was rejected or accepted. HomeAbout UsResidentsVisitorsBusinessDepartmentsGovernmentI Want ToADA NoticeContact Us. In case, you need to contact BCBS provider customer services, you can use our BCBS prefix lookup to find accurate home plan. EFT makes it possible for us to deposit electronic payments directly into your bank account. Within 60 calendar days of the reconsideration determination for services eligible for reconsideration. Submit your claims electronically! You can also mail hard copy claims to: CVS Health provides the info on the next page. 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. Share. 11:22-1.12, for disputes involving the payment of claims resulting in an adverse decision through the Companys internal appeal procedure, participating providers may access the Company's external Alternative Dispute Resolution ("ADR") mechanism. We don't automatically change procedure codes or bundle claims for covered services. 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. Authorized Representative Request. Prompt 1 (Dental plan member) Claims address Aetna PO Box 14094 Lexington, KY 40512-4094 Pharmacy 1-800-AETNA-RX (1-800-238-6279) Prompt 2 (Member or calling on behalf of a member) Providers should include their Aetna provider identification number with their documentation. We work to streamline the way we process claims. EHG independently develops and maintains its own privacy policies and practices. P.O. By mail: You can also mail hard copy claims to: The purpose of a resubmission is to get a clean claim on file. Box 14770 Lexington, KY 40512-4770. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The dentist also must state in writing that they are disputing this decision on behalf of the member. Copyright 2023 Aetna Better Health of Kansas. Submit your claims electronically! Just log in to the KMAP portal. Please fill the form out completely and mail it to: Humana Dental Claims Office P.O. Mail claims to: Aetna ATTN: Claims PO Box 14079 Lexington, KY 40512-4079 OR Fax claims to: (859)455-8650; ATTN: Claims Use Payor ID: 57604-0128, NOT the regular Aetna Payor ID MedPremier Member/Provider Services . Lexington, KY 40512 . Contact Us - Health Care Providers - Aetna If you have questions about filing a claim or the status of an existing claim, you may call us at 800-638-8432. Review the information for errors. Aetna Dental . Lexington, KY 40509 Underwriting customer . Send the request in writing to the NRLCA: Additionally, members should contact OPM by one of the following methods listed below: Address and/or Telephone Updates for Survivor Annuitants. Remember to include your subject matter, deadline and contact . In this article, I have shared all the Aetna phone numbers for providers. Fax. 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. Medicare, pharmacy and more. Unlisted, unspecified and nonspecific codes should be avoided. CPT is a registered trademark of the American Medical Association. UnitedHealthcare Community Plan of Kentucky Homepage This would follow the member appeal process. We conduct two payment cycles a week Tuesdays and Fridays: Tuesdays: Payments (checks and Remittance Advice) from this paid date are mailed Wednesday. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. More. The following is designed to give dentists step-by-step instructions to appeal a claims denial, a clinical decision or a usual and customary determination. Box 14079 6. You can also mail hard copy claims or submissions to: Use 128KYfor yourpayer ID. We offer nationwide access to CVS/Caremark network pharmacies and coverage for most FDA-approved drugs. Or choose Go on to move forward to CVS.com. Use this box for California grievances and appeals: Aetna Dental P.O. Call Aetna Mail Order Drug at 1-866-612-3862 (TTY: 711). Resources and tools Contact info . Please Note: If you discussed your claim with Aetna Member Services and your issue remains unresolved, you may call our Aetna Liaison directly at 800-232-2385 extension 775-0255. easily check the status of the claim using our Provider website or EDI 276 through your Practice Management software. If you have questions, suggestions, or even complaints, please contact us by phone or by mail. If you do need a claim form, click on the appropriate link: 2023 Aetna Claim Address| Aetna Provider Phone Number - Medical Billing RCM NRLCA 1630 Duke Street, 4th Floor (Membership) Alexandria, VA 22314-3466 or; US Office of Personal Management, Retirement Operations Center, P.O. Call HMO plan sponsor services and enrollment department at 1-855-319-7290 (TTY: 711). Cigna Electronic Payer ID 62308, Provider Phone Number and Mailing Address. Business Details Location of This Business PO Box 14089, Lexington, KY 40512-4089 Headquarters 151 Farmington Ave, Hartford, CT 06156-7003 BBB. Where do I send my claim (medical or dental)? A process known as advanced claims editing (ACE) applies coding rules to a medical claim submitted through the Availity gateway via EDI before the claim enters Humana's claim payment system. I understand that my information will be used in accordance with my plan notice of privacy practices. 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. Claims Medicare Supplement Claims 1-800-587-5139, (TTY: 711) Hours: Monday through Friday, 7 AM to 7 PM CT Agents Submit Medicare Supplemental Claims at below address: For Aetna Signature Administrators plans, Aetna Workers' Comp Access plans, Meritain Health and Schaller Anderson (Medicaid), refer to the member ID card. 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 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. Aetna Inc. and itsaffiliated 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Note: We cannot accept tertiary claims electronically. EHG independently develops and maintains its own privacy policies and practices. The status will also not show as rejected if the system cant match the information provided. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. I didn't think we had a deductible. @leecountyflbocc P.O. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Aetna ; 859-455-8650 . P.O. Copyright 2015 by the American Society of Addiction Medicine. Members can do this by filling out the Authorized Representative Request form. All Rights Reserved. Blue Cross . It contains information for health care professionals. Form to be completed with an appeal. Please Note: If you discussed your claim with Aetna Member Services and your issue remains unresolved, you may call our Aetna Liaison directly at 800-232-2385 extension 775-0255. . Or choose Go on to move forward. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. *ClaimConnect is a registered trademeark of EHG (EDI Health Group, Inc.) and its subsidiaries. Links to various non-Aetna sites are provided for your convenience only. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". If you want to stay on our site, choose the X in the upper right corner to close this message. PDF Claims Submission - AppleOne Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Call HMO plan sponsor services and enrollment department at 1-800-343-6101 (TTY: 711). You are now being directed to the CVS Health site. Download the Claim Form All clinical disputes will be reviewed by an Aetna dental consultant who was not involved in the initial determination. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Aetna Provider Phone Numbers for Claims, Eligibility, Prior Authorization and Credentialing, Final Remarks about Aetna Insurance Phone Numbers Guide, Aetna Provider Phone Numbers and Claims Address, Cigna Payer ID, Phone Number and Mailing Address, Aetna Provider Phone Numbers for Claims and Eligibility Verification, Aetna Credentialing Phone Number: 1-800-353-1232, Claims Mailing Address: PO Box 981107 El Paso, TX 79998-1107, Address for Appeals: PO Box 981107 Lexington, KY 40512, Aetna Fax Number for Appeals and Medical Records: 859-455-8650, Aetna Fax Number for EFT Request Form: 859-455-8650, Aetna Fax Number for ERA Request Form: 866-510-3710, Place of Service Codes List 2023: Latest CMS POS Codes for HCFA1500, Payer ID Lookup 2023 Updated Insurance Payor ID List, BCBS Prefix List Lookup Directory with Phone Numbers 2023, Humana Provider Phone Number for Medicare, Dental and Gold Plus.
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