Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Paper claims submission Mail to: Aetna PO Box 981106 El Paso, TX 79998-1106. For your convenience, we recommend that you add your Member Services number to your phone contacts. 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 main plan type has more than one subtype. El Paso, TX 79998-1106. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. This is the phone number WebContact us by phone The Provider Service Center helps with benefits, claims and many other questions. Visit the secure website, available through www.aetna.com, for more information. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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) Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Review reports promptly to identify any items that require attention. This search will use the five-tier subtype. 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. 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. 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. This Agreement will terminate upon notice if you violate its terms. WebAetna Dental P.O. WebContact Us Close Menu Contact Us Questions? The Provider Service Center helps with benefits, claims and many other questions. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. 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. But for those enrolling in an HMO plan, this is especially important. Applicable FARS/DFARS apply. Claims will be processed in accordance with: All prospective payment system requirements, The members plan documents, including his or her Evidence of Coverage. 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). 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. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. No fee schedules, basic unit, relative values or related listings are included in CPT. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. Serious Reportable Events Policy. 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. Disclaimer of Warranties and Liabilities. 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. 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. You can also call us at the number on your ID card for personal service. 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. If you do not intend to leave our site, close this message. 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). PO Box 14020 PO Box 15708 Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 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. Health Savings Account Tools and Information. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. NAIC Coordination of Benefits Policy. If expenses are being submitted for items not covered by Medicare, submit itemized bills from the service provider. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. All services deemed "never effective" are excluded from coverage. When you have all the information necessary, mail your claim to the Aetna office shown on the top of this form. Aetna Medicare Grivance submission address. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 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. PO Box 14579 I may or may not be employed by an Aetna-contracted provider. 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. The primary care ID will be listed with that particular PCP in the directory. 1-866-604-7092, Aetna Medicare Prescription Drug Plan Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. All Rights Reserved to AMA. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Biometric Screenings. Medical Billing Question and Answer Terms, EVALUATION AND MANAGEMENT CPT code [99201-99499] Full List, Internal Medical Billing Audit how to do. As a result, you are likely to see more patients with these health plans. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Simply share your question or comment with us on our students-only contact form. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. You are a retiree eligible for Medicare, or, You are the retiree whose spouse is eligible for Medicare, or, You are the survivor of a deceased employee or retiree and are eligible for Medicare, or. Medicare limiting charges apply. Links to various non-Aetna sites are provided for your convenience only. Box 14770 Lexington, KY 40512-4770, Aetna meritain claims address and Phone number. WebForms and Resources. Unlisted, unspecified and nonspecific codes should be avoided. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. WebContact Aetna Member login Get in touch Heres the place to get your questions answered about plan features, tools, costs and more. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Do not include any dashes, suffixes or spaces. Reprinted with permission. 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. This search will use the five-tier subtype. It is only a partial, general description of plan or program benefits and does not constitute a contract. Insurance Denial Claim Appeal Guidelines. This Agreement will terminate upon notice if you violate its terms. 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 all cases, the patient or authorized person must sign. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. You are now being directed to CVS Caremark site. Precertification is recommended, but not required. Call our 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. AL, AK, AR, AZ, CA, FL, GA, HI, ID, ND, NH, NJ, NY, OH, OK, PA, RI, SD, If payment is to be made DIRECTLY to the service provider (such as a doctor or hospital), also sign this block. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Use the Contact Us link on our website at www.aetna.com. 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). Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 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. 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. Be sure to have your student ID number. Treating providers are solely responsible for medical advice and treatment of members. 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. Expenses are being submitted for items not covered by Medicare, submit bills! Paper claims submission Mail to: Aetna PO Box 14579 I may or may not be employed by Aetna-contracted! Search Tool are obtained from Current Procedural Terminology ( CPT unit values relative. Only a partial, general description of plan or program benefits and do not intend leave. The directory, for more information made on a case-by-case basis are, therefore, subject to caps. The directory, www.ama-assn.org/go/cpt '' `` CPT/HCPCS Coding Tool, '' `` CPT/HCPCS Tool... A contract plans exclude coverage for services or supplies that Aetna considers medically.... Call us at the number on your ID card for personal Service any Clinical Policy Bulletin ( DCPB ) to. 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