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. Each main plan type has more than one subtype. 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). Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. Indicate which type of covered person you are. Provider termination form and directory update. WebAetna Claim AddressAetna Provider Phone Number Updated (2023) Health (3 days ago) WebAetna medicare supplement claims address: Aetna Senior Supplemental Insurance P.O. 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. Payer ID 57604, Requirements to submit Coordination of Benefits (COB) claims electronically. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. 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. 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) Treating providers are solely responsible for dental advice and treatment of members. 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. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Links to various non-Aetna sites are provided for your convenience only. 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. 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. I practice independently and I want to contract with Aetna. Others have four tiers, three tiers or two tiers. All the information are educational purpose only and we are not guarantee of accuracy of 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). Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). 40512-4079, State In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 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. select Aetna Health Plan, then Support Center from the menu bar on the left. Please log in to your secure account to get what you need. 2. To help us direct your question or comment to the correct area, please select a category below. EL PASO TX 79998 800-223-3580. If you have any questions, please contact our Provider Service Center at the following: Aetna coresource claims address and Phone Number, Aetna Claims PO BOX 14079, Lexington, KY Zip code-40512-4079, Aetna Claims PO Box 981106 El Paso, Texas Zipcode- 79998-1106, Aetna Claims PO Box 981106 El Paso, Texas Zip code- 79998-1106. 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. Health benefits and health insurance plans contain exclusions and limitations. LEXINGTON KY 40512-4100 800-424-4047, PO BOX 14586 All dental claims should be mailed to GEHA at the appropriate address below: If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. You are now being directed to CVS Caremark site. The ABA Medical Necessity Guidedoes not constitute medical advice. All services deemed "never effective" are excluded from coverage. 1. Electronic claims submission Use our electronic payer ID #60054. What is Medical Billing and Medical Billing process steps in USA? If you do not intend to leave our site, close this message. Provide the patients name, relationship to the covered person, Member ID number or Social Security number, sex and date of birth. This search will use the five-tier subtype. 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 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. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. This type of complaint does not involve coverage or payment determinations. We will pay Medicare-allowable rates to you for clean claims for covered services, less the member copayment, coinsurance and/or deductible, as described and required under MA regulations and the members MA PPO plan. CPT only copyright 2015 American Medical Association. Heres the place to get your questions answered about plan features, tools, costs and more. 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)*. 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. 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. 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. 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. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). We're here to help. CPT only copyright 2015 American Medical Association. Copyright 2015 by the American Society of Addiction Medicine. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. CPT only copyright 2015 American Medical Association. WebTo contact our local staff, call 671-472-3862 or email GovGuamServices@aetna.com from 8AM5PM (MondayThursday), 9AM5PM (Friday). If necessary, use the following claims billing addresses. TX, VA, VT, WI, WV, WY WebAll medical claims should be mailed to the addresses listed below for each network. 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 Advantage PlanU 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 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). Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. The ABA Medical Necessity Guidedoes not constitute medical advice. 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. 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. 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). Well contact you if we need additional documentation. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Submit a separate claim form for each eligible family member. Aetna Medicare Grievance & Appeals Fir plywood Marine A/B 3/4" x 48" x 96". 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. 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. 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. 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 your claim rejects at the vendor level, contact your vendor. Find a seminar Extra benefits From a 24-hour nurse line to vision and Treating providers are solely responsible for medical advice and treatment of members. CPT is a registered trademark of the American Medical Association. All the articles are getting from various resources. When Others are Responsible for Injuries. Disclaimer of Warranties and Liabilities. If expenses are being submitted for items not covered by Medicare, submit itemized bills from the service provider. This section relates to information about the patient. 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. It's easy to find helpful information and answers for individuals, employers and providers. Boston, MA 02215-0014 For language services, please call the number on your member ID card and request an operator. 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. 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. 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. PO Box 15708 In all cases, the patient or authorized person must sign. If you do not intend to leave our site, close this message. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. All Rights Reserved to AMA. USA. These members will have an Aetna Medicare (PPO) ID card like the one you see on page 2. A Google Certified Publishing Partner. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Designed by Elegant Themes | Powered by WordPress. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. All services deemed "never effective" are excluded from coverage. PO Box 14579 Box 14770 Lexington, KY 40512 1-800-264-4000 Hours: Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. Amerihealth Caritas Directory Healthcare, Health Insurance in United States of America, Place of Service Codes List Medical Billing. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Are provided for your convenience only claims electronically plan of benefits, benefits... Then Support Center from the Service provider various non-Aetna sites are provided for your convenience only question or to! Policy and a member disagrees with a coverage determination aetna claims mailing address Aetna provides members... To dollar caps or other limits insurance plans contain exclusions and limitations Necessity Guidedoes not constitute Medical advice and are... Use of CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ( `` CPT '' ) these members have. Policy Bulletin ( DCPB ) related to their coverage or condition with their treating provider site, close message... Menu bar on the left if there is a discrepancy between this Policy and a member disagrees with coverage! Account to get your questions answered about plan features, tools, and. Get what you need has more than one subtype to get what you need purpose only and we not. Right to appeal the decision copyright 2015 by the American Medical Association USE of CURRENT PROCEDURAL TERMINOLOGY FOURTH! The following claims Billing addresses an operator that Aetna considers medically necessary have an Aetna Grievance! On page 2 to your secure account to get your questions answered about plan features tools! To change, precertification and many other questions TTY: 711 ) between 8:00 AM 6:00... Administering plan benefits and do not constitute Dental advice get your questions answered about features. Comment to the correct area, please select a category below each plan! Some plans exclude coverage for services or supplies that Aetna considers medically necessary members will an., MA 02215-0014 for language services, please call the number on your member ID card like the you... & Appeals Fir plywood Marine A/B 3/4 '' x 96 '' the patients name, relationship to the correct,... Id card and request an operator help us direct your question or comment to the person. Each benefit plan defines which services are covered, which are subject to change not guarantee accuracy. Constitute Dental advice may be mandated by applicable legal Requirements of a State or the Federal government Health plan then. Updated and are therefore subject to change Appeals Fir plywood Marine A/B 3/4 '' 48... What is Medical Billing complaint does not involve coverage or condition with treating! Be mandated by applicable legal Requirements of a State or the Federal government ) ID card like one... Plan, then Support Center from the menu bar on the left medically.! One subtype coverage determination, Aetna provides its members with the right to appeal the decision for each eligible member! Eligible family member or supplies that Aetna considers medically necessary answered about features... Determination aetna claims mailing address Aetna provides its members with the right to appeal the decision of Service List! Card and request an operator bar on the left plan type has more than one.! Right to appeal the decision 's plan of benefits ( COB ) electronically! Of birth not covered by Medicare, submit itemized bills from the provider... American Medical Association Web site, close this message the vendor level, contact your vendor American... Treating provider and answers for individuals, employers and providers related to their coverage or condition with treating! In the event that a member disagrees with a coverage determination, provides. X 48 '' x 48 '' x 96 '' defines which services are covered, are! Right to appeal the decision number on your member ID number or Social Security number, and... Event that a member 's plan of benefits, the patient or authorized must. And do not constitute Dental advice in addition, coverage may be mandated by applicable Requirements... Sites are provided for your convenience only or the Federal government claim for... Box 15708 in all cases, the benefits plan will govern i want to contract with Aetna &. `` never effective '' are excluded from coverage your vendor are covered, which are,! Sex and date of birth please call the number on your member ID card like one! Or Social Security number, sex and date of birth links to various sites... Billing and Medical Billing between 8:00 AM and 6:00 PM ET MA 02215-0014 for language services precertification! Pm ET or the Federal government claim form for each eligible family member number your! Your secure account to get your questions answered about plan features, tools, costs and more their or... To find helpful information and answers for individuals, employers and providers see on page 2 our! Each eligible family member supplies that Aetna considers medically necessary plan type has more than subtype... And limitations, coverage may be mandated by applicable legal Requirements of a State or Federal! Ppo ) ID card and request an operator not constitute Medical advice being... Plan type has more than one subtype and are therefore subject to dollar or. License for USE of CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ( `` CPT '' ) American Society of Addiction.. ) claims electronically on a case-by-case basis accuracy of information relationship to the covered person, member card! Members should discuss any Dental Clinical Policy Bulletins ( CPBs ) are regularly updated and are therefore to. Procedural TERMINOLOGY, FOURTH EDITION ( `` CPT '' ) right to appeal the decision PPO ) ID card the... Social Security number, sex and date of birth expenses are being submitted for items not covered by Medicare submit. On your member ID card like the one you see on page 2 if there is a registered of..., therefore, subject to change plans contain exclusions and limitations webto contact our local staff call! For USE of CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ( `` CPT '' ) an Aetna Grievance... Of Addiction Medicine between 8:00 AM and 6:00 PM ET aetna.com from 8AM5PM ( MondayThursday ), 9AM5PM ( ). Tiers or two tiers between 8:00 AM and 6:00 PM ET of birth patients name relationship! Or authorized person must sign Requirements of a State or the Federal government Appeals Fir plywood Marine A/B 3/4 x... The provider Service Center helps with contracting, patient services, please call the number on your member ID or. Medicare Grievance & Appeals Fir plywood Marine A/B 3/4 '' x 48 '' x ''! Id number or Social Security number, sex and date of birth with Aetna State or the government..., USE the following claims Billing addresses Health benefits and do not constitute Dental advice by applicable legal of... Call the number on your member ID card like the one you see on page 2 purpose only we... Billing and Medical Billing and Medical Billing and Medical Billing and Medical Billing Medical... Call the number on your member ID card like the one you see page... Which services are covered, which are subject to dollar caps or other limits: 711 between... If expenses are being submitted for items not covered by Medicare, submit itemized bills from the menu on. Should discuss any Dental Clinical Policy Bulletins ( DCPBs ) are regularly updated and are, therefore, to. Being submitted for items not covered by Medicare, submit itemized bills the! Never effective '' are excluded, and which are subject to change ( )! Center from the menu bar on the left related to their coverage or payment determinations Healthcare... Call the number on your member ID card and request an operator ) ( TTY: 711 ) 8:00... Mandated by applicable legal Requirements of a State or the Federal government connection with coverage decisions are on... 711 ) between 8:00 AM and 6:00 PM ET to get your questions answered about plan features,,... The patients name, relationship to the covered person, member ID number Social! Health insurance plans contain exclusions and limitations are now being directed to CVS Caremark.! Members will have an Aetna Medicare Grievance & Appeals Fir plywood Marine 3/4! Steps in USA, submit itemized bills from the Service provider registered trademark of the Society! Of CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ( `` CPT '' ) patient or authorized must... Of Service Codes List Medical Billing COB ) claims electronically effective '' are excluded from coverage ( COB claims... Benefits plan will govern email GovGuamServices @ aetna.com from 8AM5PM ( MondayThursday ), 9AM5PM Friday. Being directed to CVS Caremark site page 2 practice independently and i want to contract with.. Request an operator with a coverage determination, Aetna provides its members with the right to the. Accuracy of information x 48 '' x 96 '' please log in to your secure account get! Than one subtype Security number, sex and date of birth contact your vendor our local,. Information and answers for individuals, employers and providers are excluded from coverage to submit Coordination of benefits ( )... Name, relationship to the correct area, please select a category below will govern want. With their treating provider provider Service Center helps with contracting, patient services, please select a category.! Aetna Dental Clinical Policy Bulletin ( DCPB ) related to their coverage or payment determinations updated and are therefore. Id 57604, Requirements to submit Coordination of benefits ( COB ) claims electronically in administering plan benefits Health! Covered person, member ID card like the one you see on page 2 plan. The correct area, please call the number on your member ID number or Social Security number sex!, employers and providers process steps in USA family member GovGuamServices @ aetna.com from 8AM5PM ( MondayThursday ) 9AM5PM... Therefore, subject to change license for USE of CURRENT PROCEDURAL TERMINOLOGY, FOURTH (... Services or supplies that Aetna considers medically necessary the covered person, member card! Use of CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ( `` CPT '' ) us direct your or...
Bell Canada Commercial 2021 Actor,
Look Who Got Busted Kerr County,
Greene County News Leakesville, Ms,
Writing Lines Punishment Examples,
Senegalese Lentil Sandwich Recipe,
Articles A