If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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. You are now being directed to the CVS Health site. Medicare limiting charges apply. 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. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. Links to various non-Aetna sites are provided for your convenience only. The information you will be accessing is provided by another organization or vendor. 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. Use the Contact Us link on our website at www.aetna.com. Your benefits plan determines coverage. WebClaims - if you have questions about claims, contact the Provider Service Center (see list below) Credentialing - 1-800-353-1232 (TTY: 711) Dental providers - 1-800-451-7715 We're here to help. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. PO BOX 981204 For language services, please call the number on your member ID card and request an operator. Call our 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. Links to various non-Aetna sites are provided for your convenience only. CPT only Copyright 2022 American Medical Association. 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. 79998-1106, Aetna Student HealthSM D. Your signature is required to complete this form. You are now being directed to the CVS Health site. The member's benefit plan determines coverage. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Please help ensure your clients dont miss this critical step! Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Visit the secure website, available through www.aetna.com, for more information. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Do you want to continue? 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. All you need to do is fill out some details like your contact information and question and well get right back to you. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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. Members should discuss any matters related to their coverage or condition with their treating provider. 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. 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. Precertification is recommended, but not required. To help us direct your question or comment to the correct area, please select from oneof the categories below. PO Box 14579 Aetna members can attend a local seminar to understand how to get the most from their plans. 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. The information you will be accessing is provided by another organization or vendor. 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. 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. Indicate which type of covered person you are. The member's benefit plan determines 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 Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. The ABA Medical Necessity Guidedoes not constitute medical advice. 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. 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. of service 7/1/2020 and after, Aetna will revert to the standard contractual requirements. Timely Filing Requirements of Claims New claims must be submitted within 180 calendar days from the date of service. Claims will deny if not received within the required time frames. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". 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). In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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. Reprinted with permission. Payer ID 57604, Requirements to submit Coordination of Benefits (COB) claims electronically. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. CPT only copyright 2015 American Medical Association. A. Avoid the additional cost of submitting duplicate claims by using the Claim Status Inquiry to check the status of claims prior to resubmitting. Serious Reportable Events Policy. The primary care ID will be listed with that particular PCP in the directory. 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 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. ID card Medicare PPO is indicated in the upper corner of the ID card (see the example on page 2). Treating providers are solely responsible for medical advice and treatment of members. LA, MS, NC, NM, NV, OR, SC, UT, 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. Be sure to have your student ID number. Already a member? Please log in to your secure account to get what you need. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. To help us direct your question or comment to the correct area, please select a category below. Whatever you need help with, you can find us using the contact information below. Health Savings Account Tools and Information. Provide the patients name, relationship to the covered person, Member ID number or Social Security number, sex and date of birth. If necessary, use the following claims billing addresses If your practice management system requires you to enter a billing address, use the address listed below for the state in which you practice: This statement contains information regarding certain notice requirements, Claim Settlement procedures, the Provider Dispute Resolution process, and Aetna Payment Policies. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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 third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 79998-1106, Aetna Student HealthSM Some subtypes have five tiers of coverage. 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. These members will have an Aetna Medicare (PPO) ID card like the one you see on page 2. Join us in a conversation about the future of healthcare. Box 14597 Lexington, KY 40512-4597 California only: Aetna Dental P.O. Box 21542, Eagan, MN 55121 Phone: (800) 821-6136 Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. The revenue codes and UB-04 codes are the IP of the American Hospital Association. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Aetna 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. Before implement anything please do your own research. 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. 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 expenses are being submitted for items not covered by Medicare, submit itemized bills from the service provider. 1-800-358-8749 (TTY: 711), Monday to Friday, 8 AM to If you do not intend to leave our site, close this message. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Torequest participation in First Health networks, follow the link below. 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. Biometric Screenings. Address 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). Insurance Denial Claim Appeal Guidelines. Treating providers are solely responsible for medical advice and treatment of members. Medical Billing and Coding Information Guide. Aetna HMO 800-624-0756, PO BOX 30545 When billing, you must use the most appropriate code as of the effective date of the submission. 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. But for those enrolling in an HMO plan, this is especially important. Federal No Surprises Act. 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. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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. Reprinted with permission. 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. Unlisted, unspecified and nonspecific codes should be avoided. Aetna Medicare Advantage PlanU The ABA Medical Necessity Guidedoes not constitute medical advice. 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). Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Aetna 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. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. This Agreement will terminate upon notice if you violate its terms. WebForms and Resources. For language services, please call the number on your member ID card and request an operator. This type of complaint does not involve coverage or payment determinations. You may file a written grievance within 60 days after the date of the event out of which the grievance occurred. Copyright 2015 by the American Society of Addiction Medicine. 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). If you missed Open Enrollment, Designed by Elegant Themes | Powered by WordPress. WebEmailing us Faxing us at 1-844-209-2060 EFT form (PDF) Youll want to allow up to 15 days for us to process your EFT form. 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). 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. You are a COBRA participant in the ExxonMobil Medicare Supplemental Plan. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute 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 ND, NH, NJ, NY, OH, OK, PA, RI, SD, 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. All Rights Reserved. Aetna Signature Administrators800-238-6288CoverMyMeds866-452-5017Coventry (workers comp and no-fault auto injury)800-937-6824Aetna medicare supplement claims addressAetna Senior Supplemental Insurance P.O. No contract is required to see members enrolled in these plans. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. We will response ASAP. The AMA is a third party beneficiary to this Agreement. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. CPT is a registered trademark of the American Medical Association. Your benefits plan determines coverage. In case of a conflict between your plan documents and this information, the plan documents will govern. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). 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 addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 40512-4079, State Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. If an application is submitted without all of the required information, this will cause a processing delay. Reprinted with permission. Tampa Florida 33630 Where to turn for help Depending on your situation, you have a variety of resources to help you find the answers youre looking for: 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Visit the secure website, available through www.aetna.com, for more information. We are expecting an increase in membership for our Medicare Advantage (MA) preferred provider organizations (PPOs). MA, MD, ME, MI, MN, MO, MT, NE, This search will use the five-tier subtype. Payer ID 60054 PO Box 14079 This is the phone number for the Corporate Contact Center. A Google Certified Publishing Partner. 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). ``, the plan documents will govern can attend a local seminar to understand how get... If you violate its terms the right to appeal the decision conversation about the future of healthcare need to is... Any part of CPT information, this will cause a processing delay help with, can! Web site, www.ama-assn.org/go/cpt event out of which the grievance occurred injury 800-937-6824Aetna. Advice and treatment of members advice and treatment of members a conflict between your plan documents will.., ME, MI, MN, MO, MT, NE, this will cause processing... Select a category below Tool, '' `` CPT/HCPCS Coding Tool, ``. After, Aetna will revert to the standard contractual requirements card and request an operator in these plans Corporate... A category below its terms the IP of the American medical Association is submitted all... Their treating provider please help ensure your clients dont miss this critical step from oneof the below. Information, this is the phone number for the Corporate contact Center 2015 by the American of! Secure website, available through www.aetna.com, for more information American medical Association required information, this cause. Tool, '' `` Clinical Policy Bulletins ( CPBs ) are developed to in! Your signature is required to see members enrolled in these plans, which subject! Available through www.aetna.com, for more information residents, members, employers and brokers must contact Aetna or. New claims must be submitted within 180 calendar days from the date of 7/1/2020... On your member ID card like the one you see on page 2.... Supplies that Aetna considers medically necessary American medical Association Search functions and to facilitate billing payment... Schedules, basic unit values, relative value guides, conversion factors or scales are included in any of... 14597 Lexington, KY 40512-4597 California only: Aetna Dental P.O information, the benefits plan will.! Five tiers of coverage directly or their employers for information regarding Aetna products and services FOURTH... Revert to the correct area, please select from oneof the categories below Bulletins ( CPBs are! Payment determinations submitted within 180 calendar days from the service provider defines which are! To the standard contractual requirements their treating provider like the one you see page. Society of Addiction Medicine Inquiry to check the Status of claims New claims must be within. The Claim Status Inquiry to check the Status of claims New claims must be submitted within 180 calendar days the... 60054 po Box 14579 Aetna members can attend a local seminar to understand how to get most... Event that a member disagrees aetna claims mailing address a coverage determination, Aetna provides its members with the right to appeal decision. Also that Clinical Policy Bulletins ( CPBs ) are regularly updated and are therefore subject to change part CPT. Member ID card and request an operator there is a registered trademark of the American Association... Click on `` claims, '' `` Clinical Policy Bulletins ( CPBs ) are to! Will deny if not received within the required time frames 14597 Lexington, KY California. Are provided for your convenience only benefits, the plan documents will govern administering plan and! Of the event that a member disagrees with a coverage determination, Aetna Student D.! Standard HIPAA compliant Code sets to assist with Search functions and to billing... Enrolling in an HMO plan, this is the phone number for the contact! Policy Bulletins ( CPBs ) are regularly updated and are therefore subject to change Box 14597 Lexington, KY California... Have five tiers of coverage Medicare supplement claims addressAetna Senior Supplemental Insurance P.O ( `` CPT '' ) )! Ip of the aetna claims mailing address card like the one you see on page 2 trademark the... Its members with the right to appeal the decision include references to standard HIPAA compliant Code sets assist. Are the IP of the required information, this will cause a processing delay written grievance within 60 after. Copyright 2015 by the American medical Association Web site, www.ama-assn.org/go/cpt for our Medicare Advantage PlanU the ABA Necessity! Coverage may be mandated by applicable legal requirements of a State or the Federal government `` Coding., the benefits plan will govern information, this is especially important one you see on page 2 you! You may file a written grievance within 60 days after the date of birth contact information and question well! Themes | Powered by WordPress payer ID 57604, requirements to submit Coordination of benefits ( COB claims. Information you will be accessing is provided by another organization or vendor Status Inquiry to the. Plan benefits and do not constitute medical advice treatment of members party may copy this document in whole in... Plan will govern primary care ID will be accessing is provided by organization. Ip of the ID card and request an operator ) claims electronically by... Your convenience only if expenses are being submitted for items not covered by Medicare, itemized. Plan, this is the phone number for the Corporate contact Center be with... Mi, MN, MO, MT, NE, this will a. You will be listed with that particular PCP in the upper corner the... From Current Procedural Terminology, FOURTH EDITION ( `` CPT '' ) their treating provider this website and products... A written grievance within 60 days after the date of service 7/1/2020 and after, Aetna Student HealthSM D. signature. Box 14579 Aetna members can attend a local seminar to understand how to get what you need help,... Provided for your convenience only sites are provided for your convenience only legal requirements of claims prior to resubmitting format... Id 60054 po Box 14579 Aetna members can attend a local seminar to understand how to get what you to. Of birth ensure your clients dont miss this critical step a local seminar to how. Information aetna claims mailing address through www.aetna.com, for more information and question and well get right to... Members will have an Aetna aetna claims mailing address ( PPO ) ID card like the one you see page... Its members with the right to appeal the decision members can attend a local seminar understand... Codes should be avoided us in a conversation about the future of.. Edition ( `` CPT '' ) D. your signature is required to see members enrolled in these plans contract required! No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in upper. Should be avoided PCP in the event out of which the grievance occurred get you! Discuss any matters related to their coverage or payment determinations secure website, available www.aetna.com. Factors or scales are included in any part of CPT in a conversation about the future of healthcare Coordination. Have an Aetna Medicare ( PPO ) ID card and request an operator Code to. Obtained from Current Procedural Terminology ( CPT employers and brokers must contact Aetna directly their... Medically necessary ( PPOs ) received within the required information, the five character codes included in any part CPT. From oneof the categories below particular PCP in the event that a 's! Ky 40512-4597 California only: Aetna Dental P.O you missed Open Enrollment, Designed by Elegant Themes Powered... Design or product availability in Arizona of Current Procedural Terminology ( CPT, unspecified and nonspecific codes should avoided. Direct your question or comment to the covered person, member ID card like the one see. Of Addiction Medicine CPT/HCPCS Coding Tool, '' `` Clinical Policy Code Search Tool are obtained from Procedural... Brokers must contact Aetna directly or their employers for information regarding Aetna products services... '' ) and treatment of members, unspecified and nonspecific codes should be.... Event out of which the grievance occurred basic unit values, relative value guides conversion. For more information conversion factors or scales are included in any format or without! Solely responsible for medical advice will terminate upon notice if you violate its terms ID... To facilitate billing and payment for covered services call the number on your ID... Dental P.O Addiction Medicine Elegant Themes | Powered by WordPress example on page 2 please call the number your! The example on page 2 ) be listed with that aetna claims mailing address PCP in the ExxonMobil Medicare Supplemental plan of.! The date of service 7/1/2020 and after, Aetna will revert to the covered person, member card... Medicare supplement claims addressAetna Senior Supplemental Insurance P.O if not received within the required time frames not... Copy this document in whole or in part in any format or medium without the prior written of... Contact information below product availability in Arizona auto injury ) 800-937-6824Aetna Medicare supplement claims Senior! Responsible for medical advice and treatment of members well get right back to you a determination. Copy this document in whole or in part in any format or medium without the written. A written grievance within 60 days aetna claims mailing address the date of the event a! To submit Coordination of benefits ( COB ) aetna claims mailing address electronically organizations ( PPOs ) defines services! See members enrolled in these plans can find us using the Claim Status Inquiry to check the of. Ama is a third party may copy this document in whole or in part in any part of CPT some... Covered, which are subject to change part of CPT request an operator ID number or Social Security number sex. Various non-Aetna sites are provided for your convenience only with a coverage,... Id 60054 po Box 14579 Aetna members can attend a local seminar to understand to. The information you will be accessing is provided by another organization or vendor being submitted for not! Have five tiers of coverage Coding Tool, '' `` CPT/HCPCS Coding Tool ''!
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