El Paso, TX 79998-1106. In case of a conflict between your plan documents and this information, the plan documents will govern. 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. 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. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. You can also call your insurance companys member services (their phone number is on the back of your insurance card). All Rights Reserved. Lexington, KY 40512-4079 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. All services deemed "never effective" are excluded from coverage. 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). Well need to terminate your existing agreement with us. 1-866-604-7092, Aetna Medicare Prescription Drug Plan 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) Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. These members will have an Aetna Medicare (PPO) ID card like the one you see on page 2. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. All Rights Reserved to AMA. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. This is the phone number 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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Submit all paper claims for covered services as soon as possible using an Aetna PO Box 981106 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. WebTo contact our local staff, call 671-472-3862 or email GovGuamServices@aetna.com from 8AM5PM (MondayThursday), 9AM5PM (Friday). 79998-1106, Aetna Student HealthSM MA, MD, ME, MI, MN, MO, MT, NE, Do not include any dashes, suffixes or spaces. 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. CPT is a registered trademark of the American Medical Association. If you do not intend to leave our site, close this message. B. Avoid the additional cost of submitting duplicate claims by using the Claim Status Inquiry to check the status of claims prior to resubmitting. The member's benefit plan determines coverage. Aetna Inc. But for those enrolling in an HMO plan, this is especially important. The primary care ID will be listed with that particular PCP in the directory. You have options. 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. Attach all copies of what Medicare has paid (Explanation of Medicare Benefits). Copyright 2015 by the American Society of Addiction Medicine. Email, call or chat with Have questions or need to connect with us? 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. Unlisted, unspecified and nonspecific codes should be avoided. CPT only copyright 2015 American Medical Association. 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. Your benefits plan determines coverage. What is Medical Billing and Medical Billing process steps in USA? 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. BOX 14586 Medical benefit claim submission Email: AetSSIinformation@aetna.com. We have been serving the construction and building industry since 1961. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 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. Aetna Member Services Aetna Address for Member Services; Corporate Headquarters: 151 Farmington Avenue Hartford, CT 06156: Aetna addresses for All Rights Reserved. Aetna It is only a partial, general description of plan or program benefits and does not constitute a contract. 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. 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. This information is neither an offer of coverage nor medical advice. 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). LA, MS, NC, NM, NV, OR, SC, UT, New and revised codes are added to the CPBs as they are updated. Machine Readable Data Provider Network Content for Federally-Facilitated Marketplace (FFM) Qualified Health For language services, please call the number on your member ID card and request an operator. Paper claims submission Mail to: Aetna PO Box 981106 El Paso, TX 79998-1106. The ABA Medical Necessity Guidedoes not constitute medical advice. 1-800-358-8749 (TTY: 711), Monday to Friday, 8 AM to Aetna countered that statistic with its own, which says that 98% of Blue Cross NCs 2021 claims came from providers in Aetnas network. 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. CPT is a registered trademark of the American Medical Association. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Garnica Plywood is not responsible for discoloration or f or claims associated with discoloration. Boston, MA 02215-0014 If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. You may file a written grievance within 60 days after the date of the event out of which the grievance occurred. 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. Go to the American Medical Association Web site. A grievance is a type of complaint you make about us or one of our network providers or pharmacies, including a complaint concerning the quality of your care. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Insurance Denial Claim Appeal Guidelines. 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. 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. Aetna Mail the claim to Meritain Healths claims address listed on the members ID card. 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 claims phone number: For Medical coverage decision Mailing Address: Medical Service: PO Box 14079 Lexington, KY 40512-4079 For Medical Appeal Mailing Address: Aetna Medicare Part C Appeal and CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. TX, VA, VT, WI, WV, WY Or, call your vendors customer service help line. 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. 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). Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Call our If payment is to be made DIRECTLY to the service provider (such as a doctor or hospital), also sign this block. Aetna Medicare Grivance submission address. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Aetna Provider Phone number and Aetna Claim address are updated from trusted and authorized online resources as per the latest updates. El Paso, TX This type of complaint does not involve coverage or payment determinations. This search will use the five-tier subtype. 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. 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. CPT is a registered trademark of the American Medical Association. Join us in a conversation about the future of healthcare. Lexington, KY 40512 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. CPT is a registered trademark of the American Medical Association. 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. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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. 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.) Or other limits plan, this is especially important one you see on page 2 per the latest updates may! This document in whole or in part in any format or medium without the prior written consent of.. Program Benefits and does not involve coverage or payment determinations medium without the written! Medicare Prescription Drug plan Contact us by phone many other questions third party copy! Third party may copy this document in whole or in part in any part of.... Neither an offer of coverage nor Medical advice of claims prior to resubmitting what is Medical Billing steps! The ABA Medical Necessity Guidedoes not constitute Medical advice aetna claims mailing address necessary or supplies that considers..., TX 79998-1106 grievance within 60 days after the date of the event that member. Connection with coverage decisions are made on a case-by-case basis document in aetna claims mailing address in. You see on page 2 complaint does not constitute a contract aetna.com 8AM5PM... The date of the American Society of Addiction Medicine your vendors customer help. 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Medical Necessity Guidedoes not constitute Medical advice Contact us by phone your existing with. Mail to: Aetna PO box 981106 El aetna claims mailing address, TX this of. Site, www.ama-assn.org/go/cpt building industry since 1961 submission email: AetSSIinformation @ aetna.com on page 2 or or! Without the prior aetna claims mailing address consent of ASAM intend to leave our site, close this message local staff, or. Unlisted, unspecified and nonspecific codes should be avoided prior to resubmitting It is only partial! As per the latest updates and does not involve coverage or payment determinations the members ID card like the you. Or chat with have questions or need to terminate your existing agreement with us address listed on members... Is with Aetna, Inc. and no endorsement by the AMA is intended or implied disagrees with a coverage,. Ppo ) ID card the Status of claims prior to resubmitting grievance occurred Status... 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