aetna claims mailing address

Aetna Provider Phone number and Aetna Claim address are updated from trusted and authorized online resources as per the latest updates. PO Box 14020 Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. 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. Box 14770 Lexington, KY 40512 1-800-264-4000 Hours: Please be sure to add a 1 before your mobile number, ex: 19876543210. Lexington, KY 40512 Dont have an account? Applicable FARS/DFARS apply. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Heres the place to get your questions answered about plan features, tools, costs and more. Fax Number: Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. If you are a nonparticipating provider in our Medicare PPO plan. WebContact Aetna Member login Get in touch Heres the place to get your questions answered about plan features, tools, costs and more. This section relates to information about the covered person. Treating providers are solely responsible for medical advice and treatment of members. 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. 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. All you need to do is fill out some details like your contact information and question and well get right back to you. 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. Box 21542, Eagan, MN 55121 Phone: (800) 821-6136 If you have questions regarding the status of a claim (for instance, whether it has been paid or processed), use our Claim Status Inquiry transaction. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. Black Friday Cyber Monday Deals Amazon 2022, For Medical coverage decision Mailing Address, Aetna Medicare Part C Appeal and Grievances PO Box 14067, For request a Drug Coverage decision Mailing Address, Aetna Medicare Coverage decisions: PO Box 7773, Council for Affordable Quality Healthcare, Aetna Voluntary and Limited Benefits Plans, Quality Point of Service ID starts without W, Coventry (workers comp and no-fault auto injury), Aetna Senior Supplemental Insurance P.O. Just log in to your member account to send us an email or chat online. WebContact us by phone The Provider Service Center helps with benefits, claims and many other questions. PO Box 14079 Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Treating providers are solely responsible for dental advice and treatment of members. In all cases, the patient or authorized person must sign. All Rights Reserved. WebContact Us Close Menu Contact Us Questions? Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Mail the claim to Meritain Healths claims address listed on the members ID card. Treating providers are solely responsible for medical advice and treatment of members. 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. LEXINGTON, KY 40512-4586, Attachment Mailing Address PO Box 981106 Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Affordable HealthChoices from Aetna, SRC, an Aetna company The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. This search will use the five-tier subtype. Applicable FARS/DFARS apply. 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 expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Go to the American Medical Association Web site. Garnica Plywood is not responsible for discoloration or f or claims associated with discoloration. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Address Reprinted with permission. The information you will be accessing is provided by another organization or vendor. 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. CPT only copyright 2015 American Medical Association. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. 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. PO Box 981106 All the contents and articles are based on our search and taken from various resources and our knowledge in Medical billing. You may file a written grievance within 60 days after the date of the event out of which the grievance occurred. 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. Box 14770 Lexington, KY 40512-4770, Aetna meritain claims address and Phone number. Already a member? The ABA Medical Necessity Guidedoes not constitute medical advice. You are now being directed to CVS Caremark site. WebTo contact our local staff, call 671-472-3862 or email GovGuamServices@aetna.com from 8AM5PM (MondayThursday), 9AM5PM (Friday). 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. 1-800-358-8749 (TTY: 711), Monday to Friday, 8 AM to LEXINGTON KY 40512-4089 800-354-5835, PO BOX 14100 The member's benefit plan determines coverage. To help us direct your question or comment to the correct area, please select from oneof the categories below. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 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. Links to various non-Aetna sites are provided for your convenience only. You are now being directed to CVS Caremark site. Review reports promptly to identify any items that require attention. Once processing is complete, well send you a Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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). 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. 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. Precertification is recommended, but not required. Unlisted, unspecified and nonspecific codes should be avoided. Aetna Inc. Please log in to your secure account to get what you need. CPT is a registered trademark of the American Medical Association. Register as a new user. The member's benefit plan determines coverage. Claims Inquiries To confirm the recorded date of claims receipt or to make other inquiries about claims, you may call Aetna at 1-800-624-0756 for Medicare HMO Products / 1-888-MD-Aetna (632-3862) for All Other Products, or contact your clearinghouse vendor. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. 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. New and revised codes are added to the CPBs as they are updated. This information is neither an offer of coverage nor medical advice. Medicare limiting charges apply. USA. For questions on how to submit electronic claims to third-party administrators, such as an individual practice association, contact the third-party administrator. Payer ID 57604, Requirements to submit Coordination of Benefits (COB) claims electronically. Or, call your vendors customer service help line. 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. All services deemed "never effective" are excluded from coverage. Box 14597 Lexington, KY 40512-4597 California only: Aetna Dental P.O. 1-866-604-7092, Aetna Medicare Prescription Drug Plan Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. When billing, you must use the most appropriate code as of the effective date of the submission. All the articles are getting from various resources. All dental claims should be mailed to GEHA at the appropriate address below: Direct Care Broker or Supplier Contracts EDI Submitter: 44054 P.O. Others have four tiers, three tiers or two tiers. All services deemed "never effective" are excluded from coverage. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Treating providers are solely responsible for dental advice and treatment of members. This Agreement will terminate upon notice if you violate its terms. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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). Go to the American Medical Association Web site. Lexington, KY Well contact you if we need additional documentation. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 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. 79998-1106, Aetna Student HealthSM We're here to help. NAIC Coordination of Benefits Policy. 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. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). When billing, you must use the most appropriate code as of the effective date of the submission. Torequest participation in First Health networks, follow the link below. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. 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. We want to make it easier for you to live healthier. The revenue codes and UB-04 codes are the IP of the American Hospital Association. 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. Medicaid Address and phone number List 1, Medicaid claim submission address List 2. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Due to current market conditions, actual product. The ABA Medical Necessity Guidedoes not constitute medical advice. All medical claims should be mailed to the addresses listed below for each network. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. The member's benefit plan determines coverage. The information you will be accessing is provided by another organization or vendor. BOX 14586 Aetna CPT 81479 oninvasive Prenatal Testing for Fetal Aneuploidies, CPT CODE 47562, 47563, 47564 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY, Top 13 denials in RCM and how to prevent the denials, Critical care codes Usage , Time, Documentation, Medical necessity condition with example, CPT Code 99201, 99202, 99203, 99204, 99205 Which code to USE. 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. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. Unlisted, unspecified and nonspecific codes should be avoided. It is only a partial, general description of plan or program benefits and does not constitute a contract. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 860 262 9111. Go to the American Medical Association Web site. 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 Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Whatever you need help with, you can find us using the contact information below. Copyright 2015 by the American Society of Addiction Medicine. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Box 10462 Van Nuys, CA 91410 Want to become a participating dentist? The ABA Medical Necessity Guidedoes not constitute medical advice. 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. The link to NCCI on the Centers for Medicare & Medicaid Services (CMS) website is www.cms.gov/nationalcorrectcodinited/. Join us in a conversation about the future of healthcare. Aetna members can attend a local seminar to understand how to get the most from their plans. Others have four tiers, three tiers or two tiers. Lexington, KY 40512-4079 PO Box 15708 In case of a conflict between your plan documents and this information, the plan documents will govern. CO, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD, ME, MI, MN, MO, MT, NE, ND, NH, NJ, NY, OH, OK, PA, RI, SD, TX, VA, VT, WI, WV, WY, Address Medicare medical and dental plans - 1-800-624-0756 (TTY: 711) Non The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Members should discuss any matters related to their coverage or condition with their treating provider. Provide the name, Member ID number or Social Security number, address and phone number of the covered person. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Some subtypes have five tiers of coverage. This form will also update your information in the online provider directory. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Each main plan type has more than one subtype. 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. For all Aetna Student Health and Medicare Plans use: For all Aetna Voluntary and Limited Benefits Plans use: Request a Medical coverage decision by Mail: Aetna Medicare Part C Appeal and Grievances. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. 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 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. PO Box 981106 All the information are educational purpose only and we are not guarantee of accuracy of information. 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. 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. select Aetna Health Plan, then Support Center from the menu bar on the left. Federal No Surprises Act. 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. Copyright 2015 by the American Society of Addiction Medicine. CPT only Copyright 2022 American Medical Association. P.O. Health Savings Account Tools and Information. 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. 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.
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