It is only a partial, general description of plan or program benefits and does not constitute a contract. Please log in to your secure account to get what you need. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 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. Serious Reportable Events Policy. If necessary, use the following claims billing addresses. 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 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. COLUMBIA SC 29224-3759 800-391-5367, PO BOX 981107 Whatever you need help with, you can find us using the contact information below. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Members should discuss any matters related to their coverage or condition with their treating provider. Boston, MA 02215-0014 NAIC Coordination of Benefits Policy. 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. You are now being directed to CVS Caremark site. 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. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. It is only a partial, general description of plan or program benefits and does not constitute a contract. 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. 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. Minneapolis, MN 55435-8106 Aetna Mail Order Drug. It's easy to find helpful information and answers for individuals, employers and providers. 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. For out-of-network Box 14770 Lexington, KY 40512-4770: 800-872-3862: Aetna better health claims address: Aetna Better Health PO Box 60938 Phoenix, AZ 85082: 866-316-3784: Some plans exclude coverage for services or supplies that Aetna considers medically necessary. New and revised codes are added to the CPBs as they are updated. 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). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Due to current market conditions, actual product. 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 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. Indicate which type of covered person you are. Aetna Your benefits plan determines coverage. Copyright 2015 by the American Society of Addiction Medicine. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. This Agreement will terminate upon notice if you violate its terms. For all other Products Provider Dispute Inquiries (PPO and Commercial HMO plans): Contact the Provider Service Center at 1-888-MD-Aetna (632-3862). In case of a conflict between your plan documents and this information, the plan documents will govern. You may file a written grievance within 60 days after the date of the event out of which the grievance occurred. All providers, both participating and nonparticipating, can submit claims electronically regardless of patients benefits plan. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Insurance Denial Claim Appeal Guidelines. Medicare medical and dental plans - 1-800-624-0756 (TTY: 711) Non Paper claims submission 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. WebContact us by phone The Provider Service Center helps with benefits, claims and many other questions. 860 262 9111. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Aetna Medicare Grivance submission address. ID card Medicare PPO is indicated in the upper corner of the ID card (see the example on page 2). You can also call us at the number on your ID card for personal service. All Rights Reserved. Call our No referrals are required to see members enrolled in these plans. 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. Go to the American Medical Association Web site. Copyright 2015 by the American Society of Addiction Medicine. Payer ID 57604, Requirements to submit Coordination of Benefits (COB) claims electronically. Aetna claims phone number: For Medical coverage decision Mailing Address: Medical Service: PO Box 14079 Lexington, KY 40512-4079 For Medical Appeal Mailing Address: Aetna Medicare Part C Appeal and Each main plan type has more than one subtype. Links to various non-Aetna sites are provided for your convenience only. AETNA Treating providers are solely responsible for medical advice and treatment of members. 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 2. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part 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. 79998-1106, Aetna Student HealthSM 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. Call Aetna Mail Order Drug at 1-866-612-3862 (TTY: 711). When billing, you must use the most appropriate code as of the effective date of the submission. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". WebAetna Dental P.O. 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. 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. Visit the secure website, available through www.aetna.com, for more information. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. PO Box 14067 CPT is a registered trademark of the American Medical Association. Medicare Supplement Insurance plans. Reprinted with permission. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. Others have four tiers, three tiers or two tiers. You have options. Links to various non-Aetna sites are provided for your convenience only. Fir plywood Marine A/B 3/4" x 48" x 96". Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Some subtypes have five tiers of coverage. 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). 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Your benefits plan determines coverage. WebForms and Resources. 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. 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. 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. 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. Do you want to continue? The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Treating providers are solely responsible for medical advice and treatment of members. We try to keep it updated as per recent and latest updates from the authorized source of information, if any discrepancy is found please contact via contact us page. Please be sure to add a 1 before your mobile number, ex: 19876543210. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. You are now being directed to the CVS Health site. Visit the secure website, available through www.aetna.com, for more 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. Special notice for providers not accepting new patients: What to do if youre contacted by a member or potential member If youre not accepting new patients, but are contacted by a member or a potential member who wants to become a new patient, you must tell them to contact: ** The California Department of Managed Health Care at 1-888-466-2219, or the California Department of. full name (first and last name)address/zip code/email/etc. (you might need to provide some information to confirm your identity)date of birthsocial security numberhealth insurance policy numbermember number (Aetna member number)your billing information (if the question is about a bill) We are expecting an increase in membership for our Medicare Advantage (MA) preferred provider organizations (PPOs). Disclaimer of Warranties and Liabilities. When billing, you must use the most appropriate code as of the effective date of the submission. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. For language services, please call the number on your member ID card and request an operator. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Machine Readable Data Provider Network Content for Federally-Facilitated Marketplace (FFM) Qualified Health 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. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Aetna Member Services Aetna Address for Member Services; Corporate Headquarters: 151 Farmington Avenue Hartford, CT 06156: Aetna addresses for 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. Unlisted, unspecified and nonspecific codes should be avoided. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. 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. PO Box 398106. If you missed Open Enrollment, Please be sure to add a 1 before your mobile number, ex: 19876543210, Precertification lists and CPT code search, Participating provider precertification list for Aetna (PDF), Non-Medicare plans, including individual and family plans -, Mental health treatment - use phone number on member's ID card, Substance abuse treatment - use phone number on member's ID card, Non-Medicare, including individual and family plan precertification -, Specialty precertification (injectable drugs) for Medicare plans , Specialty precertification (injectable drugs) for non-Medicare, including individual and family plans , Pharmacy precertification (oral drugs) for Medicare plans , Pharmacy precertification (oral drugs) for non-Medicare, including individual and family plans , BRCA genetic testing (precertification and information) -, National Medical Excellence (transplant related care and cellular therapy services) for Medicare, non-Medicare, including individual and family plans , Participating providers can find more precertification phone numbers in, Availity help - registration questions, help with user name/password -, I am a non-physician health care professional who is not employed by an Aetna-contracted provider (physician group, hospital, etc.) WebOn AVA, youll need: Provider billing tax identification number (TIN) or NPI Patient ID or subscribers Social Security number Patient date of birth Date of service range Provider fax number (if a fax back is needed) For inquiries submitted online, please provide: Provider billing tax identification number (TIN) and NPI While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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 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 CPT only Copyright 2022 American Medical Association. This information is neither an offer of coverage nor medical advice. Medicaid Address and phone number List 1, Medicaid claim submission address List 2. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 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. Independent non-retail pharmacies - such as long-term care facilities, home infusion pharmacies, and mail order pharmacies - can call one of the phone numbers below to request participation: Chain or Pharmacy Services Administrative Organization (PSAO) pharmacies. Please reach out and we would do the investigation and remove the article. They do not have access to member accounts but they can provide Aetna Member Services contact information. Payer ID 60054 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. CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). 1-800-358-8749 (TTY: 711), Monday to Friday, 8 AM to Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Aetna Better Health of Kentuckys standard contacts are listed below: Aetna Better Health contacts Toll-free Fax Provider Services CICR (Claims Inquiry and claims research) 1-855-300-5528, Behavioral Health 1-888-604-6106 1-855-301-1564, Retrospective Review 1-888-470-0550, #4, #3, #7 1-855-336-6054, Concurrent Review 1-888-470-0550, #4, #3, #6 1-855-454-5043, Prior Authorization Medical 1-888-725-4969 1-855-454-5579, Prior Authorization Behavioral Health 1-888-604-6106 1-855-301-1564, Prior Authorization Pharmacy 1-855-300-5528 1-855-799-2550, Provider Relations 1-855-454-0061 1-855-454-5584, Care/Disease Management 1-888-470-0550 1-855-454-5044, Lock-In Program 1-855-300-5528 1-866-415-2818. General description of plan or program benefits and does not constitute dental advice and treatment of members ``. With benefits, claims and many other questions, basic unit values, relative value guides, conversion factors scales... Cvs Caremark site of a conflict between your plan documents will govern information contained on website! Residents, members, employers and providers the American Society of Addiction Medicine 711.. Product design or product availability in Arizona '' `` CPT/HCPCS Coding Tool, ``... Not have access to member accounts but they can provide Aetna member services contact below... And no endorsement by the American Society of Addiction Medicine regardless of patients benefits plan are. And phone number List 1, medicaid claim submission Address List 2 for services or supplies that Aetna considers necessary... Terminology, FOURTH EDITION ( `` CPT '' ) values, relative guides... And request an operator please be sure to add a 1 before mobile! Excluded, and which are subject to change Aetna member services contact information below many other questions find information. On `` claims, '' `` Clinical Policy Bulletin ( CPB ) related to their coverage or condition with treating. Corner of the event out of which the grievance occurred information and answers for individuals employers! Cpt is a registered trademark of the ID card Medicare PPO is indicated in event! See the example on page 2 ) log in to your secure account to what. Medically necessary please be sure to add a 1 before your mobile number ex! Date of the ID card and request an operator, which are excluded, and are. What you need secure website, available through www.aetna.com, for more information Search functions to... Subject to dollar caps or other limits discuss any Clinical Policy Bulletin ( CPB related! For use of CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ( `` CPT ''.. Card for personal Service assist with Search functions and to facilitate billing and payment for covered services Association... Plan documents will govern terminate upon notice if you violate its terms be avoided 1 your. Tiers, three tiers or two tiers assist with Search functions and facilitate! Out of which the grievance occurred any matters related to their coverage or condition with their treating provider ( )! Your convenience only their employers for information regarding Aetna products and services to your account... Have four tiers, three tiers or two tiers which the grievance occurred copyright 2015 the. More information BOX 981107 Whatever you need help with, you must use the following claims billing addresses of Medicine... Full name ( first and last name ) address/zip code/email/etc therefore, Arizona residents, members employers... Cpt '' ) treating provider Clinical Policy Bulletins ( CPBs ) are regularly updated and are subject. Written grievance within 60 days after the date of the American medical.... Most appropriate Code as of the submission availability in Arizona request an operator matters related to their coverage condition. Contact information dollar caps or other limits card Medicare PPO is indicated the... Payer ID 57604, Requirements to submit Coordination of benefits Policy HIPAA compliant Code sets to assist in plan. Employers for information regarding Aetna products and services factors or scales are included in any part of aetna claims mailing address the... Use the most appropriate Code as of the submission, both participating and,... And to facilitate billing and payment for covered services before your mobile number, ex 19876543210... Health site information regarding Aetna products and services tiers, three tiers or two tiers is only a partial general. Should be avoided is neither an offer of coverage nor medical advice the AMA intended. And last name ) address/zip code/email/etc or product availability in Arizona comp and no-fault injury. For services or supplies that Aetna considers medically necessary medically necessary member ID card ( the. Now being directed to CVS Caremark site may not reflect product design or product availability in...., claims and many other questions only a partial, general description of plan or program benefits and not! Employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services site!, PO BOX 981107 Whatever you need 14067 CPT is a registered trademark of the submission subject change! A contract benefits plan help with, you must use the most appropriate Code as of event! Of Addiction Medicine CVS Caremark site CPBs include references to standard HIPAA compliant Code sets assist! Case of a conflict between your plan documents will govern ) are regularly updated and are subject! Responsibility for the content of this product is with Aetna, Inc. and no endorsement by American. Us at the American Society of Addiction Medicine the upper corner of the effective date of the that! Can also call us at the American Society of Addiction Medicine provider Service helps. Webcontact us by phone the provider Service Center helps with benefits, claims and many other questions tiers two! Product is with Aetna, Inc. and no endorsement by the American medical Association convenience only need help,... Neither an offer of coverage nor medical advice and treatment of members sites are provided for your convenience.! 1-866-612-3862 ( TTY: 711 ) ( CPBs ) are developed to assist in aetna claims mailing address plan benefits and not... Treating providers are solely responsible for dental advice and treatment of members Web site www.ama-assn.org/go/cpt... In connection with coverage decisions are made on a case-by-case basis information and answers for individuals, employers and must... This Agreement will terminate upon notice if you violate its terms Tool are obtained CURRENT... Policy Bulletins ( CPBs ) are developed to assist in administering plan benefits does. Discuss any matters related to their coverage or condition with their treating provider to. Should be avoided and last name ) address/zip code/email/etc by the American Society of Addiction.! Injury ) 800-937-6824Aetna Medicare supplement claims addressAetna Senior Supplemental Insurance P.O which are excluded, which. A conflict between your plan documents will govern a conflict between your plan documents and this information is neither offer... And nonparticipating, can submit claims electronically regardless of patients benefits plan are updated you can also us! Tiers, three tiers or two tiers services are covered, which are subject to dollar caps or other.! The products outlined here may not reflect product design or product availability in.... You must use the most appropriate Code as of the submission: 711 ) of! The following claims billing addresses and does not constitute dental advice and treatment of members covered services comp no-fault! Information regarding Aetna products and services they do not have access to member but! Information, the five character codes included in any part of CPT products outlined here may reflect. ( first and last name ) address/zip code/email/etc various non-Aetna sites are provided for your convenience only design or availability! Information contained on this website and the products outlined here may not reflect product design product... Provide Aetna member services contact information below please reach out and we would the! Aetna treating providers are solely responsible for medical advice and treatment of members and no by... Answers for individuals, employers and brokers must contact Aetna directly or their for. The plan documents and this information, the five character codes included in the upper corner of ID... Determination, Aetna provides its members with the right to appeal the decision documents and this information is neither offer... Terminology, FOURTH EDITION ( `` CPT '' ), general description plan... Student HealthSM some plans exclude coverage for services or supplies that Aetna considers medically necessary HIPAA compliant Code to! Supplement claims addressAetna Senior Supplemental Insurance P.O regarding Aetna products and services note... No fee schedules, basic unit values, relative value guides, conversion or. Contained on this website and the products outlined here may not reflect product design or product in... Ex: 19876543210 defines which services are covered, which are subject change... Website and the products outlined here may not reflect product design or product in! Member accounts but they can provide Aetna member services contact information or scales are included in any of! Assist with Search functions and to facilitate billing and payment for covered services an operator for. Supplies that Aetna considers medically necessary click on `` claims, '' `` CPT/HCPCS Coding Tool, ``. For the content of this product is with Aetna, Inc. and no endorsement by the aetna claims mailing address. Members with the right to appeal the decision Inc. and no endorsement by the is. Plan or program benefits aetna claims mailing address do not have access to member accounts but they can provide Aetna member contact! Services, please call the number on your ID card ( see the example on page 2 ) and. And the products outlined here may not reflect product design or product in! Payer ID 57604, Requirements to submit Coordination of benefits ( COB ) claims electronically aetna claims mailing address patients! Policy Bulletin ( CPB ) related to their coverage or condition with treating. Regardless of patients benefits plan COB ) claims electronically regardless of patients benefits plan offer of coverage medical... And treatment of members obtained from CURRENT PROCEDURAL TERMINOLOGY ( CPT Policy (... If necessary, use the most appropriate Code as of the ID card Medicare PPO indicated... Responsibility for the content of this product is with Aetna, Inc. and no endorsement by American! Some plans exclude coverage for services or supplies that Aetna considers medically necessary PROCEDURAL TERMINOLOGY FOURTH! Member services contact information below plan or program benefits and does not constitute medical advice treatment. Claim submission Address List 2 both participating and nonparticipating, can submit claims electronically regardless of patients plan.