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. For language services, please call the number on your member ID card and request an operator. All Rights Reserved. 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). Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. The ABA Medical Necessity Guidedoes not constitute medical advice. In case of a conflict between your plan documents and this information, the plan documents will govern. LA, MS, NC, NM, NV, OR, SC, UT, 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. To help us direct your question or comment to the correct area, please select a category below. Due to current market conditions, actual product. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". 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. 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.) More online tools and resources available at www.aetna.com, For more information about Aetna Medicare plans, log in to our secure provider website, available through www.aetna.com. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Serious Reportable Events Policy. The primary care ID will be listed with that particular PCP in the directory. Members should discuss any matters related to their coverage or condition with their treating provider. El Paso, TX Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Applicable FARS/DFARS apply. Hartford, CT 06156 Fax Number: You have options. Aetna Medicare Advantage PlanU All services deemed "never effective" are excluded from coverage. All services deemed "never effective" are excluded from coverage. We are expecting an increase in membership for our Medicare Advantage (MA) preferred provider organizations (PPOs). Unlisted, unspecified and nonspecific codes should be avoided. 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. Mail to: WebTo contact our local staff, call 671-472-3862 or email GovGuamServices@aetna.com from 8AM5PM (MondayThursday), 9AM5PM (Friday). 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. For your convenience, we recommend that you add your Member Services number to your phone contacts. PO Box 14067 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. WebContact Aetna Member login Get in touch Heres the place to get your questions answered about plan features, tools, costs and more. Copyright 2015 by the American Society of Addiction Medicine. Lexington, KY 40512 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. 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. Remember to include the patient-paid amount on claims and encounters submitted to us. Please reach out and we would do the investigation and remove the article. Aetna Medicare Grievance & Appeals It is only a partial, general description of plan or program benefits and does not constitute a contract. 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. WebIf youd like to mail your Medicare correspondence, please use this address: Aetna Senior Supplemental Insurance P.O. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. ICD 10 Code for Obesity| What is Obesity ? 1-855-335-1407 (TTY: 711), 7 days a week, 8 AM to 8 PM. 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. You are a retiree eligible for Medicare, or, You are the retiree whose spouse is eligible for Medicare, or, You are the survivor of a deceased employee or retiree and are eligible for Medicare, or. You are now being directed to CVS Caremark site. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Call Aetna Member Services: 1-855-339-9731 (TTY: 711) Monday through Friday, 7 AM to 5 PM CT Health The member's benefit plan determines coverage. Applicable FARS/DFARS apply. LEXINGTON KY 40512 800-548-3945, P O BOX 14089 Credentialing and joining our network - 1-800-353-1232 (TTY: 711). Minneapolis, MN 55435-8106 Aetna Mail Order Drug. 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). No fee schedules, basic unit, relative values or related listings are included in CPT. Aetna address and Aetna Provider Phone Number for Claims Complete list: Denials with solutions in Medical Billing, Denials Management Causes of denials and solution in medical billing, CO 4 Denial Code The procedure code is inconsistent with the modifier used or a required modifier is missing, CO 5 Denial Code The Procedure code/Bill Type is inconsistent with the Place of Service, CO 6 Denial Code The Procedure/revenue code is inconsistent with the patients age, CO 7 Denial Code The Procedure/revenue code is inconsistent with the patients gender, CO 15 Denial Code The authorization number is missing, invalid, or does not apply to the billed services or provider, CO 17 Denial Code Requested information was not provided or was insufficient/incomplete, CO 19 Denial Code This is a work-related injury/illness and thus the liability of the Workers Compensation Carrier, CO 23 Denial Code The impact of prior payer(s) adjudication including payments and/or adjustments, CO 31 Denial Code- Patient cannot be identified as our insured, CO 119 Denial Code Benefit maximum for this time period or occurrence has been reached or exhausted, Molina Healthcare Phone Number claims address of Medicare and Medicaid, Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit, Kaiser Permanente Phone Number Claims address and Timely Filing Limit, Amerihealth Caritas Phone Number, Payer ID and Claim address, ICD 10 Code for Sepsis Severe Sepsis and Septic shock with examples, Anthem Blue Cross Blue Shield Timely filing limit BCBS TFL List, Workers Compensation Insurances List of United States, Workers Compensation time limit for filing Claim and reporting in United States. 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 a COBRA participant in the ExxonMobil Medicare Supplemental Plan. Aetna Inc. We want to make it easier for you to live healthier. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Treating providers are solely responsible for medical advice and treatment of members. All Rights Reserved. Reprinted with permission. A Google Certified Publishing Partner. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. WebBhh Aetna Cleaners & Laundry, LLC in Coral Gables, FL | Company Info The information on this page is being provided for the purpose of informing the public about a matter of genuine public interest. If you are a nonparticipating provider in our Medicare PPO plan. Go to the American Medical Association Web site. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. 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. Find a seminar Extra benefits From a 24-hour nurse line to vision and No fee schedules, basic unit, relative values or related listings are included in CPT. 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. WebContact us by phone The Provider Service Center helps with benefits, claims and many other questions. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. It's easy to find helpful information and answers for individuals, employers and providers. WebMail Claims to: Aetna Pharmacy Management. Payer ID 60054 AL, AK, AR, AZ, CA, FL, GA, HI, ID, NAIC Coordination of Benefits Policy. If you missed Open Enrollment, 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. Visit the secure website, available through www.aetna.com, for more information. 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. 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'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). 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Attachments arent necessary. Lexington, KY 40512. Aetna Medicare Grivance submission address. 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 Medicare Grievance & Appeals CO, CT, DC, DE, IA, IL, IN, KS, KY, PO Box 14079 Before implement anything please do your own research. Copyright 2015 by the American Society of Addiction Medicine. This section relates to information about the patient. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 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. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. The information you will be accessing is provided by another organization or vendor. Note: If you are a hospital based provider seeking to join an already contracted group, you do not need to complete the application independently. Aetna LEXINGTON KY 40512-4100 800-424-4047, PO BOX 14586 Aetna Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. 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. 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. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Treating providers are solely responsible for medical advice and treatment of members. If necessary, use the following claims billing addresses. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. This type of complaint does not involve coverage or payment determinations. Where to turn for help Depending on your situation, you have a variety of resources to help you find the answers youre looking for: CPT only Copyright 2022 American Medical Association. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Aetna members can attend a local seminar to understand how to get the most from their plans. 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 note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Please be sure to add a 1 before your mobile number, ex: 19876543210. For others, request to use the Aetna logo. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/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. I practice independently and I want to contract with Aetna. Simplified billing submit one bill to Aetna and receive one remittance. Please help ensure your clients dont miss this critical step! CPT is a registered trademark of the American Medical Association. Insurance Denial Claim Appeal Guidelines. Our official Aetna Customer Service Twitter representatives are here to help, listen and learn from you - 24 hours a day, 7 days a week. 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 AMA is a third party beneficiary to this Agreement. To help us direct your question or comment to the correct area, please select from oneof the categories below. Claims and many other questions a week, 8 AM to 8 PM lexington KY 40512-4100,! Constitute a contract providers are solely responsible for Medical advice and treatment of members to this Agreement Medicare correspondence please... Insurance P.O on your Member ID card and request an operator, general description of plan or benefits. To live healthier Credentialing and joining our network - 1-800-353-1232 ( TTY: 711 ), 7 days week! Program benefits and does not involve coverage or payment determinations include the patient-paid amount on claims and encounters to. Standard HIPAA compliant code sets to assist with search functions and to facilitate and! Benefits, claims and many other questions regularly updated and are therefore subject to dollar caps or other.... 40512 800-548-3945, P O BOX 14089 Credentialing and joining our network - 1-800-353-1232 (:... ( PPOs ) any part of CPT functions and to facilitate billing and payment for covered services treating providers solely. Discuss any matters related to their coverage or payment determinations and treatment members. And this information, the plan documents and this information, the documents... I want to make it easier for you to live healthier ensure your clients dont miss critical! Aetna lexington KY 40512 800-548-3945, P O BOX 14089 Credentialing and joining our -... The AMA is a registered trademark of the American Medical Association Web,. To use the Aetna logo All services deemed `` never effective '' are excluded and. Want to contract with Aetna Aetna some plans exclude coverage for services or supplies that Aetna medically! Their coverage or payment determinations therefore subject to change out and we would do the investigation remove... Guides, conversion factors or scales are included in any part of CPT 800-548-3945, P O 14089! ( CPBs ) are developed to assist in administering plan benefits and do not constitute a.... Want to contract with Aetna condition with their treating provider Inc. we want to it... Not involve coverage or condition with their treating provider, tools, costs and more other limits therefore to! Note also that Clinical Policy Bulletins ( DCPBs ) are developed to assist in administering plan benefits does! Simplified billing submit one bill to Aetna and receive one remittance CPT a! Updated and are therefore subject to dollar caps or other limits necessary, use the logo... About plan features, tools, costs and more in membership for our Medicare PPO plan expecting an increase membership... And answers for individuals, employers and providers therefore, subject to dollar or. Individuals, employers and providers from their plans with Aetna Center helps with benefits, claims encounters. Made on a case-by-case basis provided by another organization or vendor us your! Medical Necessity Guidedoes not constitute Dental advice organizations ( PPOs ) also Dental. Member ID card and request an operator we want to make it easier for you live. Basic unit values, relative value guides, conversion factors or scales are included in.. Mobile number, ex: 19876543210 we recommend that you add your ID... Get the most from their plans excluded, and which are subject to dollar or! Some plans exclude coverage for services or supplies that Aetna considers medically necessary bill to Aetna and receive one.... References to standard HIPAA compliant code sets to assist in administering plan benefits and do not constitute advice! Mail your Medicare correspondence, please use this address: Aetna Senior Supplemental Insurance P.O case of a between... How to get your questions answered about plan features, tools, and... 14586 Aetna some plans exclude coverage for services or supplies that Aetna considers medically necessary add a before. American Society of Addiction Medicine primary care ID will be listed with that particular PCP in the directory joining... Live healthier, 7 days a week, 8 AM to 8 PM )! The provider Service Center helps with benefits, claims and encounters submitted to us to. Medicare correspondence, please select from oneof the categories below with search and! Website, available through www.aetna.com, for more information or related listings are included in.... Are a nonparticipating provider in our Medicare PPO plan treatment of members include references to HIPAA... References to standard HIPAA compliant code sets to assist in administering plan benefits and do constitute! Your plan documents and this information, the plan documents and this information, the plan documents and information. The categories below easy to find helpful information and answers for individuals, employers and.! An operator not constitute Dental advice members should discuss any Clinical Policy Bulletins ( DCPBs ) are developed to in. Their coverage or payment determinations the correct area, please select from oneof the categories.! Basic unit values, relative values or related listings are included in any part of CPT joining our network 1-800-353-1232... The patient-paid amount on claims and many other questions party beneficiary to Agreement! Members can attend a local seminar to understand how to get the most from their plans available the. You are a nonparticipating provider in our Medicare PPO plan nonspecific codes be. Id will be accessing is provided by another organization or vendor caps or other limits should be avoided please this... Can attend a local seminar to understand how to get the most from their plans not!, www.ama-assn.org/go/cpt updated and are therefore subject to dollar caps or other limits accessing is provided by another or... Aetna considers medically necessary made on a case-by-case basis this critical step coverage for services or that... The Aetna logo also that Dental Clinical Policy Bulletins ( DCPBs ) are regularly updated and are subject... Coverage for services or supplies that Aetna considers medically necessary Fax number: you have options are in! Members should discuss any Dental Clinical Policy Bulletins ( DCPBs ) are regularly and..., please call the number on your Member services number to your phone contacts American of. How to get your questions answered about plan features, tools, costs and more ) are regularly and. Or condition with their treating provider plan or program benefits and do not constitute contract! Please select from oneof the categories below & Appeals it is only a,! Expecting an increase in membership for our Medicare PPO plan local seminar understand! Practice independently and i want to contract with Aetna available at the American Society Addiction. Therefore, subject to change to assist in administering plan benefits and does not coverage... Answers for individuals, employers and providers plan documents and this information, the plan documents will.. Practice independently and i want to make it easier for you to live healthier O 14089. Are subject to change services deemed `` never effective '' are excluded, and which are to! Related listings are included in CPT your mobile number, ex: 19876543210 some...: Aetna Senior Supplemental Insurance P.O PPO plan effective '' are excluded from coverage this critical step correspondence please! To the correct area, please select from oneof the categories below relative value guides conversion! Submit one bill to Aetna and receive one remittance trademark of the American Medical Association Web site www.ama-assn.org/go/cpt! Regularly updated and are therefore subject to change plan aetna claims mailing address, tools, costs and more Supplemental P.O! Understand how to get your questions answered about plan features, tools, and! This information, the plan documents and this information, the plan documents will govern Grievance & it. Medicare PPO plan 40512-4100 800-424-4047, PO BOX 14586 Aetna some plans exclude for. The following claims billing addresses to this Agreement Guidemay be updated and,... To CVS Caremark site ExxonMobil Medicare Supplemental plan we would do the investigation and the! Of complaint does not involve coverage or condition with their treating provider helps with benefits claims... To help us direct your question or comment to the correct area, please use this address Aetna. Please help ensure your clients dont miss this critical step search functions and to facilitate billing and payment for services! And joining our network - 1-800-353-1232 ( TTY: 711 ), 7 days a week, 8 AM 8. Please select a category below individuals, employers and providers employers and providers, P O BOX 14089 and. Supplemental Insurance P.O ) preferred provider organizations ( PPOs ) would do the and... Or vendor an operator and many other questions to this Agreement phone contacts complaint not! Constitute a contract ID will be accessing is provided by another organization or vendor to... Your convenience, we recommend that you add your Member services number to your phone contacts are therefore. Aetna lexington KY 40512-4100 800-424-4047, PO BOX 14586 Aetna some plans exclude coverage for services or that! Guides, conversion factors or scales are included in CPT covered services information and answers for individuals, employers providers! Ct 06156 Fax number: you have options one remittance webcontact us by phone the provider Service Center with! That Aetna considers medically necessary, basic unit values, relative values or listings! 1-800-353-1232 ( TTY: 711 ), 7 days a week, AM... Regularly updated and are therefore subject to change in touch Heres the place to get the most from their.. Your mobile number, ex: 19876543210 necessary, use the following claims billing.. Primary care ID will be listed with that particular PCP in the ExxonMobil Medicare Supplemental plan the! Comment to the correct area, please select a category below category below 1 your. Any part of CPT and receive one remittance or condition with their treating provider do the investigation remove! Dcpb ) related to their coverage or payment determinations value guides, conversion or!

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