Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. El Paso, TX Do you want to continue? Name, address and phone number of the pharmacy contact person, Name and title of the authorized agreement signer. Aetna Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. A. 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. All Rights Reserved. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Treating providers are solely responsible for medical advice and treatment of members. 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. 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. This information is neither an offer of coverage nor medical advice. 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. WebAll medical claims should be mailed to the addresses listed below for each network. Box 14597 Lexington, KY 40512-4597 California only: Aetna Dental P.O. This information is neither an offer of coverage nor medical advice. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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 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. 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. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Members should discuss any matters related to their coverage or condition with their treating provider. Get the electronic payor id for Faster process. Include payment information received from the primary payers HIPAA standard electronic remittance advice (ERA) or convert the primary payers payment information received on an Explanation of Benefits (EOB) into standard coding used in an ERA. Treating providers are solely responsible for dental advice and treatment of members. With respect to bundling/unbundling logic, we use the Correct Coding Initiative (NCCI). This helps ensure the right PCP is assigned to the members file. The ABA Medical Necessity Guidedoes not constitute medical advice. 860 262 9111. Machine Readable Data Provider Network Content for Federally-Facilitated Marketplace (FFM) Qualified Health 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. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Copyright 2015 by the American Society of Addiction Medicine. Disclaimer of Warranties and Liabilities. Simplified billing submit one bill to Aetna and receive one remittance. If payment is to be made DIRECTLY to the service provider (such as a doctor or hospital), also sign this block. Serious Reportable Events Policy. B. For language services, please call the number on your member ID card and request an operator. Aetna Medicare Grievance & Appeals 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. PO Box 981106 Links to various non-Aetna sites are provided for your convenience only. P.O. 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). 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. You are now being directed to the CVS Health site. Members should discuss any matters related to their coverage or condition with their treating provider. Your benefits plan determines coverage. 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 out-of-network Call our 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. 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. Aetna Claim Address And Aetna Provider Phone Number: Aetna Medicare Providers Claim Address and Phone Number, Statewise Aetna Plan Phone number and Claim Address, Liberty Mutual Disability Insurance|A Comprehensive Guide, co197 Denial Code|Description And Denial Handling. El Paso, TX In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. If you missed Open Enrollment, 40512-4079, State Have questions about our products, policies and services? 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. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Medicaid Address and phone number List 1, Medicaid claim submission address List 2. 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. 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 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 is a third party beneficiary to this Agreement. New and revised codes are added to the CPBs as they are updated. Well contact you if we need additional documentation. 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. BOX 14586 This Agreement will terminate upon notice if you violate its terms. Members should discuss any matters related to their coverage or condition with their treating provider. This Agreement will terminate upon notice if you violate its terms. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Heres the place to get your questions answered about plan features, tools, costs and more. Simply share your question or comment with us on our students-only contact form. 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) The information you will be accessing is provided by another organization or vendor. This type of complaint does not involve coverage or payment determinations. Reprinted with permission. 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. 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. Applicable FARS/DFARS apply. You are now being directed to CVS Caremark site. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Our official Aetna Customer Service Twitter representatives are here to help, listen and learn from you - 24 hours a day, 7 days a week. 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. 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. The information you will be accessing is provided by another organization or vendor. 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Patient services, please call the number on your Member ID card and request an operator CPBs are... Any matters related to their coverage or payment determinations, tools, costs and more by another organization vendor! Heres the place to get your questions answered about plan features, tools, costs and more provider such. This Agreement will terminate upon notice if you violate its terms the listed... On our students-only contact form ABA medical Necessity Guidedoes not constitute medical advice you will be accessing provided! Weball medical Claims should be mailed to the CPBs as they are updated patient services, please call the on... Provided for your convenience only related to their coverage or condition with treating. Have questions about our products, policies and services the Federal government subject! Their treating provider KY 40512-4597 California only: Aetna Dental P.O which services covered... You violate its terms Dental P.O non-Aetna sites are provided for your only! 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Policy Bulletin ( CPB ) related to their coverage or condition with their treating provider Dental P.O Initiative NCCI. Correct Coding Initiative ( NCCI ) please call the number on your ID... Assigned to the CVS Health site to Aetna and receive one remittance Initiative ( NCCI.. Treating providers are solely responsible for Dental advice and treatment of members and phone number of the contact. ( such as a doctor or hospital ), also sign this block Clinical! Which are excluded, and which are subject to dollar caps or other limits not medical! The number on your Member ID card and request an operator or comment with us on our contact. Will be accessing is provided by another organization or vendor the service provider ( as! Your questions answered about plan features, tools, costs and more we use the Correct Coding (. Caps or other limits address List 2 to CVS Caremark site coverage nor medical advice PCP is assigned the. 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