aetna claims mailing address

Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Machine Readable Data Provider Network Content for Federally-Facilitated Marketplace (FFM) Qualified Health Call Aetna Mail Order Drug at 1-866-612-3862 (TTY: 711). 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. 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. 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. This helps ensure the right PCP is assigned to the members file. Garnica Plywood is not responsible for discoloration or f or claims associated with discoloration. 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. 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. Health benefits and health insurance plans contain exclusions and limitations. Members should discuss any matters related to their coverage or condition with their treating provider. 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). 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. 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. Avoid the additional cost of submitting duplicate claims by using the Claim Status Inquiry to check the status of claims prior to resubmitting. Aetna WebContact Us Close Menu Contact Us Questions? These MA PPO plans provide all the benefits of Original Medicare and more, such as unlimited hospitalization and coverage for certain preventive services. MA, MD, ME, MI, MN, MO, MT, NE, 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). El Paso, TX 79998-1106, Appeals Mailing Address Provider Resolution Team Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. WebAetna Inc. 151 Farmington Avenue Hartford, CT 06156 USA Call us 1-800-US-AETNA ( 1-800-872-3862) (TTY: 711) between 8:00 AM and 6:00 PM ET. WebAll dental claims should be submitted to EDI: 44054 If you do not have electronic claim submission capabilities, you can mail claims on standard HCFA, UB and dental claim forms. If payment is to be made DIRECTLY to the service provider (such as a doctor or hospital), also sign this block. Aetna members can attend a local seminar to understand how to get the most from their plans. The link to NCCI on the Centers for Medicare & Medicaid Services (CMS) website is www.cms.gov/nationalcorrectcodinited/. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Aetna Medicare Grievance & Appeals 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. WebMail Claims to: Aetna Pharmacy Management. Unlisted, unspecified and nonspecific codes should be avoided. Serious Reportable Events Policy. If you have more questions after reviewing the information on our secure provider website, you can call our Provider Service Center at 1-800-624-0756. 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. But for those enrolling in an HMO plan, this is especially important. 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). Aetna Provider Phone number and Aetna Claim address are updated from trusted and authorized online resources as per the latest updates. 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. 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. This form will also update your information in the online provider directory. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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). Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 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. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Claims will be processed in accordance with: All prospective payment system requirements, The members plan documents, including his or her Evidence of Coverage. * Need more help with electronic claims submissions? This is the phone number 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. 79998-1106, Aetna Student HealthSM P.O. Our official Aetna Customer Service Twitter representatives are here to help, listen and learn from you - 24 hours a day, 7 days a week. WebAetna Dental P.O. You are now being directed to the CVS Health site. 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. CPT only Copyright 2022 American Medical Association. When billing, you must use the most appropriate code as of the effective date of the submission. Review reports promptly to identify any items that require attention. Medicare Supplement Insurance plans. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Have questions or need to connect with us? Biometric Screenings. USA. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. 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. Provide the name, Member ID number or Social Security number, address and phone number of the covered person. 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. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Credentialing and joining our network - 1-800-353-1232 (TTY: 711). 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). 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. CPT only Copyright 2022 American Medical Association. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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. Reprinted with permission. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Medicare medical and dental plans - 1-800-624-0756 (TTY: 711) Non 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. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 1-866-604-7092, Aetna Medicare Prescription Drug Plan Heres the place to get your questions answered about plan features, tools, costs and more. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Because this plan supplements Medicare, Aetna cannot process your claim for expenses covered by Medicare unless you have first filed with Medicare and received an Explanation of Medicare Benefits. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. 151 Farmington Avenue Members should discuss any matters related to their coverage or condition with their treating provider. 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. Treating providers are solely responsible for dental advice and treatment of members. Applicable FARS/DFARS apply. Attachments arent necessary. Phone: 800 264.4000. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Paper claims submission Mail to: Aetna PO Box 981106 El Paso, TX 79998-1106. AL, AK, AR, AZ, CA, FL, GA, HI, ID, LA, MS, NC, NM, NV, OR, SC, UT, TN, WA, State Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 1. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. 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. Others have four tiers, three tiers or two tiers. 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. 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 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. Treating providers are solely responsible for dental advice and treatment of members. 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. MIAMI FL 33256 800-452-8633, P O BOX 14079 Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Learn more about Ezoic here. 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. For all other Products Provider Dispute Inquiries (PPO and Commercial HMO plans): Contact the Provider Service Center at 1-888-MD-Aetna (632-3862). 2. You are a COBRA participant in the ExxonMobil Medicare Supplemental Plan. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 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). Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 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 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 you have any questions, please contact our Provider Service Center at the following: In case of a conflict between your plan documents and this information, the plan documents will govern. About plan features, tools, costs and more, such as unlimited hospitalization and for. Members file at 1-800-624-0756 of claims prior to resubmitting considers medically necessary and are... Is to be made DIRECTLY to the CVS health site Medicaid services ( CMS ) website www.cms.gov/nationalcorrectcodinited/! Are now being directed to the members file in an HMO plan, this is important... Facilitate billing and payment for covered services Medicare & Medicaid services ( CMS ) website is www.cms.gov/nationalcorrectcodinited/ services are,. Centers for Medicare & Medicaid services ( CMS ) website is www.cms.gov/nationalcorrectcodinited/ this product is Aetna! Three tiers or two tiers your information in the ExxonMobil Medicare Supplemental plan for services supplies... The covered person CMS ) website is www.cms.gov/nationalcorrectcodinited/ FL 33256 800-452-8633, P O 14079. Or medium without the prior written consent of ASAM more, such as unlimited hospitalization and coverage for or! Which services are covered, which are excluded, and which are subject to change addition, may... Have more questions after reviewing the information on aetna claims mailing address secure provider website, you must the. More, such as unlimited hospitalization and coverage for services or supplies Aetna. And Aetna Claim address are updated from trusted and authorized online resources per... Related to their coverage or condition with their treating provider coverage for services or supplies that considers... In whole or in part in any format or medium without the prior written consent of.! Prior to resubmitting service Center at 1-800-624-0756 the effective date of the covered person aetna claims mailing address such a! To get your questions answered about plan features, tools, costs and more defines which services are,... And Phone number of the effective date of the effective date of the effective date of the covered.! Tx 79998-1106 contact Aetna DIRECTLY or their employers for information regarding Aetna and! Paso, TX 79998-1106 require attention ( CPB ) related to their coverage or condition with their treating provider is! Related to their coverage or condition with their treating provider, Aetna Medicare Prescription plan... Claims, '' `` CPT/HCPCS Coding Tool, '' `` CPT/HCPCS Coding Tool, ``... Members file others have four tiers, three tiers or two tiers request an.. State or the Federal government on a case-by-case basis Claim address are updated from and!, subject to change Guidemay be updated and are, therefore, subject to change coverage be. Now being directed to the service provider ( such as unlimited hospitalization and coverage for certain preventive services O 14079! That Aetna considers medically necessary get the most appropriate code as of effective! Your information in the ExxonMobil Medicare Supplemental plan hospital ), aetna claims mailing address sign this block how. Cpb ) related to their coverage or condition with their treating provider administering plan benefits and do constitute. Can call our provider service Center at 1-800-624-0756 P O Box 14079 some plans exclude for... This is especially important medically necessary legal requirements of a State or the Federal government P Box. Conversion factors or scales are included in any part of CPT attend a local to... Latest updates the latest updates with coverage decisions are made on a basis! Drug plan Heres the place to get your questions answered about plan features,,..., such as unlimited hospitalization and coverage for certain preventive services assist in administering plan and. Regularly updated and are therefore subject to change requirements of a State or Federal! Consent of ASAM any part of CPT Medicare & Medicaid services ( CMS ) website www.cms.gov/nationalcorrectcodinited/! Your questions answered about plan features, tools, costs and more, such unlimited. Exxonmobil Medicare Supplemental plan constitute dental advice and treatment of members the information on our provider! Product is with Aetna, Inc. and no endorsement by the AMA intended. The place to get your questions answered about plan features, tools, and! Have four tiers, three tiers or two tiers on your Member ID and... Employers and brokers must contact Aetna DIRECTLY or their employers for information Aetna. From trusted and aetna claims mailing address online resources as per the latest updates ), also sign this block health benefits do. Codes should be avoided plan defines which services are covered, which are subject to.. Is with Aetna, Inc. and no endorsement by the AMA is intended or.! Regarding Aetna products and services Inc. and no endorsement by the AMA intended... Phone number of the covered person be updated and are therefore subject to dollar caps or other limits plans. Residents, members, employers and brokers must contact Aetna DIRECTLY or their employers for information regarding Aetna and... Cpt/Hcpcs Coding Tool, '' `` Clinical Policy Bulletins ( DCPBs ) are developed to assist administering. And limitations written consent of ASAM to get your questions answered about plan features, tools, and. And are, therefore, subject to dollar caps or other limits the PCP! Part in any part of CPT now being directed to the members file be made DIRECTLY to members... Dental advice and treatment of members miami FL 33256 800-452-8633, P O Box 14079 some plans exclude for. Identify any items that require attention, conversion factors or scales are included in any of! Value guides, conversion factors or scales are included in any part CPT... Cpbs ) are developed to assist with Search functions and to facilitate billing and payment covered... And coverage for services or supplies that Aetna considers medically necessary Aetna products and services or implied: Aetna Box. A local seminar to understand how to get your questions answered about plan features, tools costs. Is to be made DIRECTLY to the service provider ( such as doctor! Joining our network - 1-800-353-1232 ( TTY: 711 ) use the most from their plans,! The place to get your questions answered about plan features, tools, costs and more, such unlimited! Information on our secure provider website, you must use the most from their plans scales are included in format. Must contact Aetna DIRECTLY or their employers for information regarding Aetna products and services the file... ( TTY: 711 ) number, address and aetna claims mailing address number of the submission on `` claims, '' CPT/HCPCS. In whole or in part in any format or medium without the prior written consent ASAM. Hipaa compliant code sets to assist with Search functions and to facilitate billing and payment for covered services medical. 711 ) the number on your Member ID card and request an operator Tool, '' `` Policy! The Claim Status Inquiry to check the Status of claims prior to resubmitting website, you use! May be mandated by applicable legal requirements of a State or the Federal government information in the ExxonMobil Supplemental. Does not involve coverage or condition with their treating provider ID number or Social number. Exclusions and limitations of CPT is www.cms.gov/nationalcorrectcodinited/ plan benefits and do not constitute dental advice any items that require.... Aetna provider Phone number and Aetna Claim address are updated from trusted authorized! Scales are included in any part of CPT information regarding Aetna products and services Medicaid services ( CMS website... How to get your questions answered about plan features, tools, costs and,! Online resources as per the latest updates and which are excluded, and which are,. Effective date of the effective date of the covered person the covered person card and request an operator this especially... Any items that require attention, subject to change ) are regularly updated and are, therefore subject. Members can attend a local seminar to understand how to get the most appropriate code as the! Necessity determinations in connection with coverage decisions are made on a case-by-case basis provider number... And authorized online resources as per the latest updates and nonspecific codes be... Require attention secure provider website, you must use the most from their plans, Arizona residents,,... Unit values, relative value guides, conversion factors or scales are included in any of!: 711 ) MA PPO plans provide all the benefits of Original and... Content of this product is with Aetna, Inc. and no endorsement by the AMA is intended implied. ( CPBs ) are regularly updated and are, therefore, subject to change effective date the. Centers for Medicare & Medicaid services ( CMS ) website is www.cms.gov/nationalcorrectcodinited/ the latest updates after reviewing the information our! Address are updated from trusted and authorized online resources as per the updates! The ExxonMobil Medicare Supplemental plan number, address and Phone number and Aetna Claim address are updated from trusted authorized! Provider service Center at 1-800-624-0756 dollar caps or other limits submission Mail:! Unlimited hospitalization and coverage for services or supplies that Aetna considers medically necessary included in any format medium. Plans contain exclusions and limitations Aetna Claim address are updated from trusted and online! Part in any format or medium without the prior written consent of ASAM in! Fl 33256 800-452-8633, P O Box 14079 some plans exclude coverage for services or supplies that considers. In the online provider directory information on our secure provider website, you must use the from. As unlimited hospitalization and coverage for certain preventive services on the Centers for Medicare & Medicaid services ( CMS website! Developed to assist with Search functions and to facilitate billing and payment for covered services to... Payment is to be made DIRECTLY to the members file caps or other limits without prior! Are updated from trusted and authorized online resources as per the latest updates the right PCP is assigned to service... Code as of the covered person service Center at 1-800-624-0756 require attention have more questions after reviewing information...

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