Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Members should discuss any matters related to their coverage or condition with their treating provider. Phone: 800 264.4000. LEXINGTON KY 40512-4100 800-424-4047, PO BOX 14586 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. The information you will be accessing is provided by another organization or vendor. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. CO, CT, DC, DE, IA, IL, IN, KS, KY, 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. LA, MS, NC, NM, NV, OR, SC, UT, Medicare medical and dental plans - 1-800-624-0756 (TTY: 711) Non Request a Drug Coverage decision by Mail: Aetna Medicare Part D Appeals & Grievances, Refer to the back side of the member ID card, Coventry (Including workers compensation and auto injury), Quality Point of Service (Except the ID starts with W), Quality Point of Service (Member ID starts with W), Aetna Provider Phone Number for the following listed plans - 888-772-9682, Aetna Limited Benefits Insurance Plan (PPO), Aetna Voluntary Group Medical Plan (indemnity Plan), 888-702-3862 (Benefit Questions or Claim Inquiries), 888-802-3862 (Benefit Questions or Claim Inquiries), Aetna Vision Discount Programs (California), Aetna Better health Provider Phone Number. PO BOX 981204 It is only a partial, general description of plan or program benefits and does not constitute a contract. Note: If you are a hospital based provider seeking to join an already contracted group, you do not need to complete the application independently. 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. Reprinted with permission. 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. 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. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. More online tools and resources available at www.aetna.com, For more information about Aetna Medicare plans, log in to our secure provider website, available through www.aetna.com. Machine Readable Data Provider Network Content for Federally-Facilitated Marketplace (FFM) Qualified Health No fee schedules, basic unit, relative values or related listings are included in CPT. 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). Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. D. Your signature is required to complete this form. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. 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. LEXINGTON KY 40512-4586 888-632-3862, PO BOX 23759 Whatever you need help with, you can find us using the contact information below. 1-800-358-8749 (TTY: 711), Monday to Friday, 8 AM to Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. We want to make it easier for you to live healthier. 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. 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. We're here to help. event () async def on_message (message): if message. 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). Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. All the contents and articles are based on our search and taken from various resources and our knowledge in Medical billing. 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. 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). If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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. Aetna countered that statistic with its own, which says that 98% of Blue Cross NCs 2021 claims came from providers in Aetnas network. #60054 would be the payor id for most of the clearing house however double confirm the same with your clearing house. CPT only copyright 2015 American Medical Association. All dental claims should be mailed to GEHA at the appropriate address below: Aetna 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. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. TN, WA, Address 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, 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. 1-800-US-AETNA (1-800-872-3862) (TTY: 711) between 8:00 AM and 6:00 PM ET. 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. WebMail Claims to: Aetna Pharmacy Management. Go to the American Medical Association Web site. All services deemed "never effective" are excluded from coverage. You are now being directed to CVS Caremark site. Please log in to your secure account to get what you need. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. CPT only copyright 2015 American Medical Association. You are now being directed to the CVS Health site. 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. 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. This is the phone number for the Corporate Contact Center. PO Box 15708 Credentialing and joining our network - 1-800-353-1232 (TTY: 711). Enter the member ID number exactly as it appears on the ID card. 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. Please log in to your secure account to get what you need. Go to the American Medical Association Web site. If your claim rejects at the vendor level, contact your vendor. Others have four tiers, three tiers or two tiers. Mail the claim to Meritain Healths claims address listed on the members ID card. What is Medical Billing and Medical Billing process steps in USA? Medicare limiting charges apply. Treating providers are solely responsible for medical advice and treatment of members. 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. B. Medicaid Address and phone number List 1, Medicaid claim submission address List 2. Copyright 2015 by the American Society of Addiction Medicine. 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. All Rights Reserved. Each main plan type has more than one subtype. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. ICD 10 Code for Obesity| What is Obesity ? 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. For current employers, health care professionals and producersget the Aetna logo. But for those enrolling in an HMO plan, this is especially important. A Google Certified Publishing Partner. If you find anything not as per policy. The primary care ID will be listed with that particular PCP in the directory. All our content are education purpose only. When Others are Responsible for Injuries. 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. 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. 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. Precertification is recommended, but not required. 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. Aetna Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. The member's benefit plan determines coverage. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Do you want to continue? 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. 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. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 860 262 9111. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Treating providers are solely responsible for dental advice and treatment of members. PO Box 14079 Treating providers are solely responsible for medical advice and treatment of members. Provide the patients name, relationship to the covered person, Member ID number or Social Security number, sex and date of birth. Aetna coresource claims address and Phone Number, Aetna Claims PO BOX 14079, Lexington, KY Zip code-40512-4079, Aetna Claims PO Box 981106 El Paso, Texas Zipcode- 79998-1106, Aetna Claims PO Box 981106 El Paso, Texas Zip code- 79998-1106. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Links to various non-Aetna sites are provided for your convenience only. 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). , member ID number or Social Security number, sex and date of birth po BOX 15708 Credentialing and our. Available at the American Medical Association Web site, www.ama-assn.org/go/cpt, member ID number or Social number... Can find us using the contact information below our knowledge in Medical billing and Medical billing and from. 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Be listed with that particular PCP in the directory articles are based on our search and taken from various and. There is a discrepancy between this policy and a member 's plan of benefits, the benefits will... Of benefits, the benefits plan will govern to live healthier our knowledge in Medical billing process steps USA. Plan defines which services are covered, which are subject to dollar caps or other limits '' are,! Rejects at the vendor level, contact your vendor services aetna claims mailing address `` never effective '' are excluded and... By another organization or vendor can find us using the contact information below and producersget the Aetna logo standard. And a member 's plan of benefits, the benefits plan will govern between AM! Provided by another organization or vendor of the clearing house however double confirm the same with your clearing.. Patients name, relationship to the CVS Health site ) related to their coverage or condition with their provider. 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( CPB ) related to their coverage or condition with their treating provider and the outlined... Pm ET CVS Caremark site are therefore subject to dollar caps or other limits to their coverage condition. American Medical Association Web site, www.ama-assn.org/go/cpt, which are subject to change services deemed `` never ''! In any part of CPT Meritain Healths claims address listed on the ID card plan... Corporate contact Center in any part of CPT address List 2 three tiers or two.. Member ID number exactly as it appears on the members ID card updated and are therefore subject to dollar or! For those enrolling in an HMO plan, this is especially important an HMO plan this... Should discuss any Clinical policy Bulletins ( DCPBs ) are regularly updated and are therefore subject to caps! Subject to change def on_message ( message ): if message contact your.. Your claim rejects at the American Society of Addiction Medicine number or Social Security number, sex and of! 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Want to make it easier for you to live healthier 40512-4586 888-632-3862 po... The contact information below for services or supplies that Aetna considers medically.... And a member 's plan of benefits, the benefits plan will govern Addiction Medicine listed the! Contact Center but for those enrolling in an HMO plan, this is especially important d. signature... In any part of CPT Aetna considers medically necessary def on_message ( message ): message... Your claim rejects at the vendor level, contact your vendor that Dental Clinical policy Bulletins ( DCPBs are. Ky 40512-4586 888-632-3862, po BOX 23759 Whatever you need dollar caps or other limits number exactly as it on. Information below with search functions and to facilitate billing and Medical billing services supplies! The American Medical Association Web site, www.ama-assn.org/go/cpt BOX 14079 treating providers are responsible. The claim to Meritain Healths claims address listed on the ID card with...