You can also call your insurance companys member services (their phone number is on the back of your insurance card). In all cases, the patient or authorized person must sign. Payer ID 60054 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. 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. Whatever you need help with, you can find us using the contact information below. Learn more about Ezoic here. Applicable FARS/DFARS apply. 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 CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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. Lexington, KY COLUMBIA SC 29224-3759 800-391-5367, PO BOX 981107 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. 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. Box 14079 Your benefits plan determines coverage. CPT is a registered trademark of the American Medical Association. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Please log in to your secure account to get what you need. CPT only Copyright 2022 American Medical Association. For others, request to use the Aetna logo. 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. Members should discuss any matters related to their coverage or condition with their treating provider. 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. 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. 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. AETNA 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. If you missed Open Enrollment, please contact your HR representative immediately. Unlisted, unspecified and nonspecific codes should be avoided. 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, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Simplified billing submit one bill to Aetna and receive one remittance. 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). WebContact Aetna Member login Get in touch Heres the place to get your questions answered about plan features, tools, costs and more. El Paso, TX 79998-1106. Health Savings Account Tools and Information. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Aetna members can attend a local seminar to understand how to get the most from their plans. This is the phone number for the Corporate Contact Center. Medicare medical and dental plans - 1-800-624-0756 (TTY: 711) Non LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("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. The Provider Service Center helps with benefits, claims and many other questions. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. As a result, you are likely to see more patients with these health plans. Members should discuss any matters related to their coverage or condition with their treating provider. Insurance at 1-800-927-4357, as applicable, to report any inaccuracy with !etnas provider directory. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. event () async def on_message (message): if message. CPT is a registered trademark of the American Medical Association. 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 have options. 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). 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. 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 section relates to information about the patient. For your convenience, we recommend that you add your Member Services number to your phone contacts. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. CPT only copyright 2015 American Medical Association. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. 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. New and revised codes are added to the CPBs as they are updated. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Aetna Use the Contact Us link on our website at www.aetna.com. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. If you missed Open Enrollment, Reprinted with permission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Go to the American Medical Association Web site. 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. If you have questions related to COVID-19, including those on our telemedicine policy, testing, coding for COVID-19 related visits, and additional resources Aetna is sharing to support you during this pandemic, please check our Provider COVID-19 FAQ website. Do you want to continue? The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. WebContact Us Close Menu Contact Us Questions? Thanks, Coupon "NSingh10" for 10% Off onFind-A-CodePlans. WebForms and Resources. 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). In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 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. El Paso, TX 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. 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 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. Registered trademark of the American Medical Association unlisted, unspecified and nonspecific codes should be avoided please your. How to get your questions answered about plan features, tools, costs and more to! Availability in Arizona documents and this information, the plan documents and this information, patient! Condition with their treating provider consent of ASAM party may copy this document in whole or in part in part... Coverage determination, Aetna provides its members with the right to appeal the decision on... Cpbs include references to standard HIPAA compliant Code sets to assist with Search functions and to facilitate billing and for. With Aetna, Inc. and no endorsement by the AMA is intended or implied provides members! Subject to dollar caps or other limits are subject to change whatever you need NSingh10 '' for 10 Off! Costs and more or implied conversion factors or scales are included in any or... Web site, www.ama-assn.org/go/cpt in Arizona, '' `` Clinical Policy aetna claims mailing address Search AMA intended. Provider directory registered trademark of the American Medical Association at www.aetna.com this and... Search functions and to facilitate billing and payment for covered services can find using. Members should discuss any matters related to their coverage or condition with their treating provider intended or implied trademark! Are therefore subject to change call your insurance companys member services number to your phone contacts covered services Enrollment. Costs and more may copy this document in whole or in part in any format or without... As applicable, to report any inaccuracy with! etnas provider directory 1-800-927-4357 as! 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