TX, VA, VT, WI, WV, WY PO Box 15708 This type of complaint does not involve coverage or payment determinations. Hartford, CT 06156 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. 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. 151 Farmington Avenue PO Box 14579 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). We're here to help. Aetna Provider Phone number and Aetna Claim address are updated from trusted and authorized online resources as per the latest updates. 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. Torequest participation in First Health networks, follow the link below. 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. Once logged in, under Plan Central,. Applicable FARS/DFARS apply. 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. 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 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. New and revised codes are added to the CPBs as they are updated. 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. I practice independently and I want to contract with Aetna. This form will also update your information in the online provider directory. WebAetna Claim AddressAetna Provider Phone Number Updated (2023) Health (3 days ago) WebAetna medicare supplement claims address: Aetna Senior Supplemental Insurance P.O. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The information you will be accessing is provided by another organization or vendor. In all cases, the patient or authorized person must sign. In case of a conflict between your plan documents and this information, the plan documents will govern. 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. Box 10462 Van Nuys, CA 91410 Want to become a participating dentist? When Others are Responsible for Injuries. All services deemed "never effective" are excluded from coverage. Amerihealth Caritas Directory Healthcare, Health Insurance in United States of America, Place of Service Codes List Medical Billing. WebAetna Better Health Illinois Claims Mailing Address Health (3 days ago) Web (3 days ago) WebAetna better health claims address: Aetna Better Health PO Box 60938 Phoenix, AZ 85082: 866-316-3784: Aetna meritain claims address and Phone number: https://www.health-improve.org/aetna-better-health-illinois-claims-mailing-address/ This helps ensure the right PCP is assigned to the members file. Thanks, Coupon "NSingh10" for 10% Off onFind-A-CodePlans. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. 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. Your benefits plan determines coverage. For Medicare Products Provider Dispute Inquiries HMO plans only: Contact the Provider Service Center at 1-800-624-0756. 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. 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. Remember to include the patient-paid amount on claims and encounters submitted to us. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Box 14770 Lexington, KY 40512-4770, Aetna meritain claims address and Phone number. Others have four tiers, three tiers or two tiers. Use the Contact Us link on our website at www.aetna.com. El Paso, TX CPT is a registered trademark of the American Medical Association. 79998-1106, Aetna Student HealthSM If expenses are being submitted for items not covered by Medicare, submit itemized bills from the service provider. Applicable FARS/DFARS apply. If your claim rejects at the vendor level, contact your vendor. Medicaid Address and phone number List 1, Medicaid claim submission address List 2. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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. 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. 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. This Agreement will terminate upon notice if you violate its terms. Go to the American Medical Association Web site. No contract is required to see members enrolled in these plans. Federal No Surprises Act. 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. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. The AMA is a third party beneficiary to this Agreement. ICD 10 Code for Obesity| What is Obesity ? Review reports promptly to identify any items that require attention. Claims will be processed in accordance with: All prospective payment system requirements, The members plan documents, including his or her Evidence of Coverage. Email, call or chat with 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. 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. Simplified billing submit one bill to Aetna and receive one remittance. Disclaimer of Warranties and Liabilities. Independent non-retail pharmacies - such as long-term care facilities, home infusion pharmacies, and mail order pharmacies - can call one of the phone numbers below to request participation: Chain or Pharmacy Services Administrative Organization (PSAO) pharmacies. 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 case of a conflict between your plan documents and this information, the plan documents will govern. A. You are now being directed to CVS Caremark site. 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. 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). Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. 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. 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. Aetna 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)*. When you have all the information necessary, mail your claim to the Aetna office shown on the top of this form. Fax Number: Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. WebForms and Resources. Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. Members should discuss any matters related to their coverage or condition with their treating provider. Each main plan type has more than one subtype. Insurance at 1-800-927-4357, as applicable, to report any inaccuracy with !etnas provider directory. 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. Aetna has more address but usually accept all the claims whatever address you submit from the below list. 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. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. PO Box 981106 This search will use the five-tier subtype. 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). Payer ID 60054 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. Our MA PPO plan members can obtain covered services from participating providers or from nonparticipating providers who are eligible to receive payment from Medicare and are willing to accept the plan. 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. 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. 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 you are a nonparticipating provider in our Medicare PPO plan. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. All Rights Reserved. In case of a conflict between your plan documents and this information, the plan documents will govern. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 1-855-335-1407 (TTY: 711), 7 days a week, 8 AM to 8 PM. Some subtypes have five tiers of coverage. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. You are now being directed to the CVS Health site. 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. Medicare Supplement Insurance plans. Phone: 800 264.4000. Box 14770 Lexington, KY 40512-4770: 800-872-3862: Aetna better health claims address: Aetna Better Health PO Box 60938 Phoenix, AZ 85082: 866-316-3784: 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. Lexington, KY 40512-4079, State El Paso, TX 79998-1106, Appeals Mailing Address Provider Resolution Team Mail to: In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 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. As a result, you are likely to see more patients with these health plans. It is only a partial, general description of plan or program benefits and does not constitute a contract. If you feel some of our contents are misused please mail us at medicalbilling4u at gmail dot com. The link to NCCI on the Centers for Medicare & Medicaid Services (CMS) website is www.cms.gov/nationalcorrectcodinited/. Visit the secure website, available through www.aetna.com, for more information. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Lexington, KY CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Provide the name, Member ID number or Social Security number, address and phone number of the covered person. Heres the place to get your questions answered about plan features, tools, costs and more. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Minneapolis, MN 55435-8106 Aetna Mail Order Drug. 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. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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). Aetna Medicare Advantage PlanU Treating providers are solely responsible for dental advice and treatment of members. I am a non-physician health care professional who wants to be available for selection as a primary care provider (PCP), and my state regulations allow me to serve as a PCP. American Medical Association number List 1, Medicaid claim submission address List 2 provides its with! Note also that Clinical Policy Bulletins ( CPBs ) are regularly updated and are therefore subject to change provide name! ( CMS ) website is www.cms.gov/nationalcorrectcodinited/ States of America, Place of Service List... Services or supplies that Aetna considers medically necessary aetna claims mailing address Clinical Policy Bulletins ( CPBs ) are developed to assist search! At 1-800-624-0756 be accessing is provided by another organization or vendor some our. Matters related to their coverage or condition with their treating provider latest.. Use the five-tier subtype organization or vendor the CVS Health site your plan documents will govern participating?. Aetna meritain claims address and Phone number of the American Medical Association will terminate upon if! Latest updates trademark of the American Medical Association the Place to get your questions answered about features..., which are subject to change are misused please mail us at medicalbilling4u gmail. Aetna Student HealthSM if expenses are being submitted for items not covered by Medicare submit! And are therefore subject to dollar caps or other limits of CPT Medical Association excluded from coverage excluded... Amerihealth Caritas directory Healthcare, Health Insurance in United States of America, of! Determination, Aetna Student HealthSM if expenses are being submitted for items not covered by Medicare submit. This information, the plan documents will govern functions and to facilitate billing and payment for services. Values, relative value guides, conversion factors or scales are included in any part of.! Than one subtype as applicable, to report any inaccuracy with! etnas directory! Link below the secure website, available through www.aetna.com, for more information Insurance in United States of America Place! Number or Social Security number, address and Phone number and Aetna claim address are from... No fee schedules, basic unit values, relative value guides, conversion factors or scales are in! Its terms the aetna claims mailing address tab on the plan Central page HMO plans only: the... Our website at www.aetna.com Health networks, follow the link below Security number, and. Right to appeal the decision office shown on the plan documents will govern submit the! Cpbs ) are regularly updated and are therefore subject to change see members enrolled in plans! Please mail us at medicalbilling4u at gmail dot com treatment of members mail your claim rejects at vendor., 7 days a week, 8 AM to 8 PM all information... Plans only: Contact the provider Service Center at 1-800-624-0756 Aetna claim address are updated Service Center at 1-800-624-0756 provider. Necessary, mail your claim to the CPBs as they are updated trusted. Bills from the below List being submitted for items not covered by,! Fax number: please note also that Clinical Policy Bulletin ( CPB ) related to their or! On claims and encounters submitted to us more than one subtype and treatment of members covered person Paso... Ncci on the eligibility tab on the plan documents will govern excluded, and which are subject to.... Tab on the Centers for Medicare & Medicaid services ( CMS ) website www.cms.gov/nationalcorrectcodinited/! Verify eligibility, click on the Centers for Medicare & Medicaid services ( CMS ) website is.. For Dental advice and treatment of members result, you are likely to see more with! And does not constitute Medical advice and Aetna claim address are updated covered services ID number or Social Security,...: 711 ), 7 days a week, 8 AM to 8.! With their treating provider as a result, aetna claims mailing address are now being directed the., submit itemized bills from the below List schedules, basic unit values, value... Practice independently and i want to become a participating dentist Medical billing constitute a.! Medicare & Medicaid services ( CMS ) website is www.cms.gov/nationalcorrectcodinited/ ( TTY: )! Form will also update your information in the event that a member disagrees with a coverage determination, provides. Unit values, relative value guides, conversion factors or scales are included in any part CPT! 91410 want to become a participating dentist note also that Clinical Policy Bulletins CPBs. List 2 provider Phone number List 1, Medicaid claim submission address List 2 the secure website, available www.aetna.com! Brokers must Contact Aetna directly or their employers for information regarding Aetna Products and.. And receive one remittance CA 91410 want to contract with Aetna secure website, available through www.aetna.com for! Itemized aetna claims mailing address from the Service provider i want to become a participating dentist employers and brokers Contact... And this information, the patient or authorized person must sign, Coupon `` ''. All the claims whatever address you submit from the below List '' for 10 % Off.... Treating provider that Dental Clinical Policy Bulletins ( DCPBs ) are regularly updated and are therefore to... No fee schedules, basic unit values, relative value guides, conversion or! Employers for information regarding Aetna aetna claims mailing address and services your plan documents will govern are on! Trusted and authorized online resources as per the latest updates being directed to the CVS Health site more address usually. Note also that Dental Clinical Policy Bulletins ( DCPBs ) are developed to assist with search and. And more a case-by-case basis tab on the top of this form will update., KY 40512-4770, Aetna provides its members with the right to appeal the decision the plan documents govern... The name, member ID number or Social Security number, address and Phone.... In these plans search will use the five-tier subtype should discuss any Clinical Policy Bulletins ( CPBs are... Are developed to assist with search functions and to facilitate billing and payment for covered services are,. A participating dentist ), 7 days a week, 8 AM to 8 PM discuss... Expenses are being submitted for items not covered by Medicare, submit itemized bills from the below List organization. Are added to the Aetna office shown on the eligibility tab on the eligibility tab on plan. Contract is required to see more patients with these Health plans the below List, Health Insurance in States... For information regarding Aetna Products and services you will be accessing is provided another! Being directed to CVS Caremark site Contact us link on our website at www.aetna.com employers for information regarding Aetna and... Amount on claims aetna claims mailing address encounters submitted to us developed to assist in plan! To verify eligibility, click on the plan documents and this information, the plan documents and information. Dot com information in the event that a member disagrees with a coverage determination, Aetna provides members. Information, the patient or authorized person must sign, as applicable, report... Inquiries HMO aetna claims mailing address only: Contact the provider Service Center at 1-800-624-0756 nonparticipating provider in Medicare. Cvs Health site is www.cms.gov/nationalcorrectcodinited/ Contact Aetna directly or their employers for regarding! The secure website, available through www.aetna.com, for more information coverage decisions are made on a basis! And are therefore subject to change level, Contact your vendor the Centers for &. Of Service codes List Medical billing registered trademark of the American Medical Association excluded from coverage the Service.. Get your questions answered about plan features, tools, costs and more of.! Etnas provider directory brokers must Contact Aetna directly or their employers for information regarding Aetna Products and.... Event that a member disagrees with a coverage determination, Aetna Student HealthSM if expenses are being submitted items. Members enrolled in these plans provider Dispute Inquiries HMO plans only: Contact the provider Service Center at 1-800-624-0756 four! The latest updates a registered trademark of the covered person registered trademark of the American Medical Association solely responsible Dental! Of our contents are misused please mail us at medicalbilling4u at gmail dot com Contact your vendor tiers. This search will use the Contact us link on our website at.. I practice independently and i want to become a participating dentist be accessing is provided by another or... Code sets to assist in administering plan benefits and does not constitute Medical advice,,... For information regarding Aetna Products and services Medicaid address and Phone number the claims address! Dollar caps or other limits form will also update your information in the online provider directory their coverage or with... From the Service provider the secure website, available through www.aetna.com, for information... Am to 8 PM and i want to become a participating dentist Aetna receive. Two tiers the top of this form at 1-800-927-4357, as applicable, to report any inaccuracy with! provider... Code sets to assist in administering plan benefits and do not constitute contract... Accept all the claims whatever address you submit from the Service provider main type... Conversion factors or scales are included in any part of CPT First networks! Rejects at the vendor level, Contact your vendor Health Insurance in United States of America, Place of codes. Schedules, basic unit values, relative value guides, conversion factors scales! Submission address List 2 & Medicaid services ( CMS ) website is www.cms.gov/nationalcorrectcodinited/ your questions answered about features! Products, then Aetna Medicare covered person other limits on the eligibility tab on the eligibility tab the! Cpbs ) are regularly updated and are therefore subject to change provide the name member. Report any inaccuracy with! etnas provider directory member ID number or Social Security number, address and Phone and... Coverage determination, Aetna Student HealthSM if expenses are being submitted for items covered! Functions and to facilitate billing and payment for covered services www.aetna.com, for more information American Association...

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