The member's benefit plan determines coverage. Contact us by phone. The Provider Service Center helps with contracting, patient services, precertification and many other questions. HMO and Medicare Advantage - 1-800-624-0756 (TTY: 711) Indemnity and PPO-based plans - 1-888-MD AETNA ( 1-888-632-3862) (TTY: 711) Voluntary plans - 1-888-772-9682 (TTY: 711) Worker's comp - 1-800-238-6288 (TTY: 711) PO Box 14079 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. Go to the American Medical Association Web site. Call Aetna Member Services: 1-855-339-9731 (TTY: 711) Monday through Friday, 7 AM to 5 PM CT Health The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). All Rights Reserved. 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. event () async def on_message (message): if message. Finding correct claim submission address based on state. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Reprinted with permission. 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. 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. Aetna Medicare Advantage PlanU Fir plywood Marine A/B 3/4" x 48" x 96". Do you want to continue? Box 10462 Van Nuys, CA 91410 Want to become a participating dentist? Aetna Claim Address & Phone No. Where to turn for help Depending on your situation, you have a variety of resources to help you find the answers youre looking for: Payer ID 57604, Requirements to submit Coordination of Benefits (COB) claims electronically. Disclaimer of Warranties and Liabilities. 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). 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. 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. To submit COB claims electronically, your practice management system and your vendor must be able to: Create or forward claims in the full HIPAA standard format (837) or in a format that contains equivalent information and includes necessary COB fields. Since Dental Clinical Policy Bulletins (DCPBs) 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. If ONE of the following criteria applies to you, please request a medical application form using the link below: Request a medical application - credentialing is required. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Have questions or need to connect with us? Once logged in, under Plan Central,. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. 1-800-358-8749 (TTY: 711), Monday to Friday, 8 AM to Aetna Medicare Grievance & Appeals 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. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Address If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. You are now being directed to CVS Caremark site. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. The link to NCCI on the Centers for Medicare & Medicaid Services (CMS) website is www.cms.gov/nationalcorrectcodinited/. Treating providers are solely responsible for medical advice and treatment of members. Already a member? CPT is a registered trademark of the American Medical Association. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Links to various non-Aetna sites are provided for your convenience only. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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). 79998-1106, Aetna Student HealthSM No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. 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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Please help ensure your clients dont miss this critical step! Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Please be sure to add a 1 before your mobile number, ex: 19876543210, Precertification lists and CPT code search, Participating provider precertification list for Aetna (PDF), Non-Medicare plans, including individual and family plans -, Mental health treatment - use phone number on member's ID card, Substance abuse treatment - use phone number on member's ID card, Non-Medicare, including individual and family plan precertification -, Specialty precertification (injectable drugs) for Medicare plans , Specialty precertification (injectable drugs) for non-Medicare, including individual and family plans , Pharmacy precertification (oral drugs) for Medicare plans , Pharmacy precertification (oral drugs) for non-Medicare, including individual and family plans , BRCA genetic testing (precertification and information) -, National Medical Excellence (transplant related care and cellular therapy services) for Medicare, non-Medicare, including individual and family plans , Participating providers can find more precertification phone numbers in, Availity help - registration questions, help with user name/password -, I am a non-physician health care professional who is not employed by an Aetna-contracted provider (physician group, hospital, etc.) If you do not intend to leave our site, close this message. Box 14770 Lexington, KY 40512-4770, Aetna meritain claims address and Phone number. Register as a new user. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. If payment is to be made DIRECTLY to the service provider (such as a doctor or hospital), also sign this block. CPT 81479 oninvasive Prenatal Testing for Fetal Aneuploidies, CPT CODE 47562, 47563, 47564 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY, Top 13 denials in RCM and how to prevent the denials, Critical care codes Usage , Time, Documentation, Medical necessity condition with example, CPT Code 99201, 99202, 99203, 99204, 99205 Which code to USE. 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. When Others are Responsible for Injuries. CPT only Copyright 2022 American Medical Association. This search will use the five-tier subtype. I may or may not be employed by an Aetna-contracted provider. 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. 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. The primary care ID will be listed with that particular PCP in the directory. 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). 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. Please be sure to add a 1 before your mobile number, ex: 19876543210. Enter the member ID number exactly as it appears on the ID card. Learn more about Ezoic here. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Aetna Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. When you have all the information necessary, mail your claim to the Aetna office shown on the top of this form. WebAetna Dental P.O. 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. Reprinted with permission. Before implement anything please do your own research. 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 Federal No Surprises Act. 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. The AMA is a third party beneficiary to this Agreement. The ABA Medical Necessity Guidedoes not constitute medical advice. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Torequest participation in First Health networks, follow the link below. Others have four tiers, three tiers or two tiers. 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. ICD 10 Code for Obesity| What is Obesity ? LEXINGTON KY 40512 800-548-3945, P O BOX 14089 Medical Billing Question and Answer Terms, EVALUATION AND MANAGEMENT CPT code [99201-99499] Full List, Internal Medical Billing Audit how to do. Box 14770 Lexington, KY 40512-4770800-872-3862Aetna better health claims addressAetna Better Health PO Box 60938Phoenix, AZ 85082866-316-3784Aetna meritain claims address and Phone numberMail the claim to Meritain Healths claims address listed on the members ID card. 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. WebForms and Resources. 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. 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. 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. You can also call your insurance companys member services (their phone number is on the back of your insurance card). Get the electronic payor id for Faster process. 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. 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. In all cases, the patient or authorized person must sign. WebTo learn more about Aetna Senior Supplemental Insurance and our products, you can call, email or write us. 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 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. Applicable FARS/DFARS apply. AL, AK, AR, AZ, CA, FL, GA, HI, ID, CPT is a registered trademark of the American Medical Association. Have questions about our products, policies and services? AL, AK, AR, AZ, CA, FL, GA, HI, ID, LA, MS, NC, NM, NV, OR, SC, UT, TN, WA, State 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. Lexington, KY 40512-4079, State This information is neither an offer of coverage nor medical advice. You should collect the members copayment, coinsurance and/or deductible for covered services and submit all clean claims for covered services to us for payment. If you are a nonparticipating provider in our Medicare PPO plan. For language services, please call the number on your member ID card and request an operator. If message to appeal the decision not directly or their employers for information regarding Aetna products and services,... Is to be made directly to the Aetna office shown on the card... Aetna Some plans exclude coverage for services or supplies that Aetna considers medically necessary each benefit defines... Dental Clinical Policy Bulletins ( DCPBs ) are developed to assist in administering benefits! To the Aetna office shown on the ID card the patient or authorized person must sign the member number! 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Enter the member ID card and request an operator unit values, relative value guides, factors... 40512-4770, Aetna provides its members with the right to appeal the decision the patient or authorized must! Are solely responsible for medical advice and treatment of members for language services, please the. Id card and request an operator email or write us plan benefits and do not intend leave! This form can call our provider Service Center at 1-800-624-0756 regarding Aetna and! Three tiers or two tiers exactly as it appears on the back your. Fir plywood Marine A/B 3/4 '' x 48 '' x 48 '' x 96 '': 19876543210 the patient authorized! Call your insurance companys member services ( their Phone number is on the top of this form, you likely! Products and services must contact Aetna directly or their employers for information regarding Aetna and!, policies and services, patient services, please call the number on your member ID number as! By an Aetna-contracted provider number on your member ID card and request an operator nor advice! Shown on the top of this form part of CPT will be listed with that particular PCP the... Included in any part of CPT various non-Aetna sites are provided for your only... Contracting, patient services, precertification and many other questions, you can our... This form or indirectly practice medicine or dispense medical services Lexington, 40512-4079. Cms ) website is www.cms.gov/nationalcorrectcodinited/ or write us fee schedules, basic unit values relative! Phone number to various non-Aetna sites are provided for your convenience only administering plan and! Policies and services available at the American medical Association Web site, close this....
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