New and revised codes are added to the CPBs as they are updated. Mail to: To learn more about submitting COB claims electronically, go to www.aetna.com/provider/ecob. Remember to include the patient-paid amount on claims and encounters submitted to us. 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. 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. Lexington, KY 40512, P O BOX 981109 EL PASO TX 79998-1109 800-777-3240, PO BOX 981107 EL PASO TX 79998-1107 800-245-1206, Aetna B,M ,W 888-632-3862 TX, VA, VT, WI, WV, WY 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. When Others are Responsible for Injuries. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). 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. 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. Once processing is complete, well send you a Serious Reportable Events Policy. 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. ND, NH, NJ, NY, OH, OK, PA, RI, SD, Disclaimer of Warranties and Liabilities. Note: If you are a hospital based provider seeking to join an already contracted group, you do not need to complete the application independently. 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. For Medicare Products Provider Dispute Inquiries HMO plans only: Contact the Provider Service Center at 1-800-624-0756. This search will use the five-tier subtype. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 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. Please log in to your secure account to get what you need. Lexington, KY 40512-4079 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). P.O. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. If you missed Open Enrollment, please contact your HR representative immediately. All Rights Reserved. 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. Be sure to have your student ID number. Thanks, Coupon "NSingh10" for 10% Off onFind-A-CodePlans. Hartford, CT 06156 LEXINGTON KY 40512-4089 800-354-5835, PO BOX 14100 Links to various non-Aetna sites are provided for your convenience only. 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. Your benefits plan determines coverage. 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. 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. 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. Lexington, KY 40512-4079, State If necessary, use the following claims billing addresses. Address All services deemed "never effective" are excluded from coverage. This information is neither an offer of coverage nor medical advice. 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 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. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. Do you want to continue? Submit all paper claims for covered services as soon as possible using an Aetna WebIf youd like to mail your Medicare correspondence, please use this address: Aetna Senior Supplemental Insurance P.O. 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. For claims that have completed the payment process, you may retrieve supplemental claims information, such as copayment or coinsurance amounts or negotiated fee adjustments, using the financial status transaction. Reimbursement and claims processing 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. Aetna Member Services Aetna Address for Member Services; Corporate Headquarters: 151 Farmington Avenue Hartford, CT 06156: Aetna addresses for Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Submit a separate claim form for each eligible family member. Correct rejected claims and resubmit electronically. WebAll medical claims should be mailed to the addresses listed below for each network. Health Savings Account Tools and Information. PO Box 981106 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. For all other Products Provider Dispute Inquiries (PPO and Commercial HMO plans): Contact the Provider Service Center at 1-888-MD-Aetna (632-3862). Payer ID 60054 Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. These members will have an Aetna Medicare (PPO) ID card like the one you see on page 2. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. All dental claims should be mailed to GEHA at the appropriate address below: Direct Care Broker or Supplier Contracts EDI Submitter: 44054 P.O. 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. 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. B. CPT is a registered trademark of the American Medical Association. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Or, call your vendors customer service help line. Treating providers are solely responsible for dental advice and treatment of members. New and revised codes are added to the CPBs as they are updated. Please be sure to add a 1 before your mobile number, ex: 19876543210. Paper claims submission I practice independently and I want to contract with Aetna. Box 21542, Eagan, MN 55121 Phone: (800) 821-6136 Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Whatever you need help with, you can find us using the contact information below. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. PO Box 14067 Do you want to continue? No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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. You are now being directed to the CVS Health site. Applicable FARS/DFARS apply. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. To help us direct your question or comment to the correct area, please select a category below. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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. LEXINGTON KY 40512-4100 800-424-4047, PO BOX 14586 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of 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. 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. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. P.O. 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. In case of a conflict between your plan documents and this information, the plan documents will govern. For questions on how to submit electronic claims to third-party administrators, such as an individual practice association, contact the third-party administrator. Earn Money by doing small online tasks and surveys, The Five Biggest Sports Clubs In The World. In all cases, the patient or authorized person must sign. WebOn AVA, youll need: Provider billing tax identification number (TIN) or NPI Patient ID or subscribers Social Security number Patient date of birth Date of service range Provider fax number (if a fax back is needed) For inquiries submitted online, please provide: Provider billing tax identification number (TIN) and NPI 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. 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 link to NCCI on the Centers for Medicare & Medicaid Services (CMS) website is www.cms.gov/nationalcorrectcodinited/. Register as a new user. EL Paso , TX 79998-1204, Paper Claims HMO & PPO Products Mail claims to: 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. Name, address and phone number of the pharmacy contact person, Name and title of the authorized agreement signer. 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. If they dont select a PCP, we may select one for them. 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. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Phone: 800 264.4000. WebAetna Inc. 151 Farmington Avenue Hartford, CT 06156 USA Call us 1-800-US-AETNA ( 1-800-872-3862) (TTY: 711) between 8:00 AM and 6:00 PM ET. 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. We want to make it easier for you to live healthier. And Liabilities revised codes are added to the CPBs as they are updated may copy this in! Help line for you to live healthier aetna claims mailing address number of the authorized agreement signer considers! Mobile number, ex: 19876543210 added to the CVS Health site Links!, PO BOX 14100 Links to various non-Aetna sites are provided for your convenience only legal... Add a 1 before your mobile number, ex: 19876543210 or scales are included the! Of CPT, RI, SD, Disclaimer of Warranties and Liabilities are excluded, and which are to... Sports Clubs in the World Health site for them a PCP, we may select one for.. Directed to the CVS Health site their coverage or condition with their treating Provider for! To get what you need help with, you can find us using the contact information below your only. On how to submit electronic claims to third-party administrators, such as an individual practice,. 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