No fee schedules, basic unit, relative values or related listings are included in CPT. 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. event () async def on_message (message): if message. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Treating providers are solely responsible for dental advice and treatment of members. LEXINGTON KY 40512 800-548-3945, P O BOX 14089 Medicare Supplement Insurance plans. The member's benefit plan determines coverage. Aetna Medicare Advantage PlanU 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. 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. Our official Aetna Customer Service Twitter representatives are here to help, listen and learn from you - 24 hours a day, 7 days a week. PO Box 14079 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. 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. 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. All the information are educational purpose only and we are not guarantee of accuracy of information. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Already a member? Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 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. 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: 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. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Learn more about Ezoic here. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. MIAMI FL 33256 800-452-8633, P O BOX 14079 PO Box 14079 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. Lexington, KY 40512. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Chain or PSAO pharmacies can request to participate in our Part D retail pharmacy network by emailing us this information: E-mail your pharmacy information to Aetna. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. If necessary, use the following claims billing addresses If your practice management system requires you to enter a billing address, use the address listed below for the state in which you practice: This statement contains information regarding certain notice requirements, Claim Settlement procedures, the Provider Dispute Resolution process, and Aetna Payment Policies. 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. Lexington, KY 40512, P O BOX 981109 EL PASO TX 79998-1109 800-777-3240, PO BOX 981107 EL PASO TX 79998-1107 800-245-1206, Aetna B,M ,W 888-632-3862 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 you do not intend to leave our site, close this message. Box 14770 Lexington, KY 40512 1-800-264-4000 Hours: Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". If you missed Open Enrollment, Black Friday Cyber Monday Deals Amazon 2022, For Medical coverage decision Mailing Address, Aetna Medicare Part C Appeal and Grievances PO Box 14067, For request a Drug Coverage decision Mailing Address, Aetna Medicare Coverage decisions: PO Box 7773, Council for Affordable Quality Healthcare, Aetna Voluntary and Limited Benefits Plans, Quality Point of Service ID starts without W, Coventry (workers comp and no-fault auto injury), Aetna Senior Supplemental Insurance P.O. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 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. Review reports promptly to identify any items that require attention. CPT only copyright 2015 American Medical Association. Members should discuss any matters related to their coverage or condition with their treating provider. 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. New and revised codes are added to the CPBs as they are updated. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. El Paso, TX 79998-1106. 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. PO Box 14020 Aetna Some subtypes have five tiers of coverage. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Our MA PPO plan members can obtain covered services from participating providers or from nonparticipating providers who are eligible to receive payment from Medicare and are willing to accept the plan. Aetna 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. Before implement anything please do your own research. COLUMBIA SC 29224-3759 800-391-5367, PO BOX 981107 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. If you do not intend to leave our site, close this message. Please log in to your secure account to get what you need. You are now being directed to CVS Caremark site. 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. 1-800-US-AETNA (1-800-872-3862) (TTY: 711) between 8:00 AM and 6:00 PM ET. In case of a conflict between your plan documents and this information, the plan documents will govern. This section relates to information about the patient. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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. CPT is a registered trademark of the American Medical Association. Please be sure to add a 1 before your mobile number, ex: 19876543210. All Rights Reserved to AMA. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Lexington, KY 40512 The information you will be accessing is provided by another organization or vendor. It is only a partial, general description of plan or program benefits and does not constitute a contract. To submit COB claims electronically, your practice management system and your vendor must be able to: Create or forward claims in the full HIPAA standard format (837) or in a format that contains equivalent information and includes necessary COB fields. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Mail the claim to Meritain Healths claims address listed on the members ID card. 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 a registered trademark of the American Medical Association. 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. 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. 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 information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Lexington, KY 40512-4079, State Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Minneapolis, MN 55435-8106 Aetna Mail Order Drug. Treating providers are solely responsible for medical advice and treatment of members. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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). This search will use the five-tier subtype. 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. The ABA Medical Necessity Guidedoes not constitute medical advice. 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. El Paso, TX 79998-1106, Appeals Mailing Address Provider Resolution Team All medical claims should be mailed to the addresses listed below for each network. 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. Aetna countered that statistic with its own, which says that 98% of Blue Cross NCs 2021 claims came from providers in Aetnas network. 40512-4079, State Whatever you need help with, you can find us using the contact information below. Disclaimer of Warranties and Liabilities. Links to various non-Aetna sites are provided for your convenience only. 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. PO Box 981106 What is Medical Billing and Medical Billing process steps in USA? Attachments arent necessary. Due to current market conditions, actual product. This information is neither an offer of coverage nor medical 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. Independent retail pharmacies can fill out the form at the link below. Unlisted, unspecified and nonspecific codes should be avoided. P.O. Treating providers are solely responsible for medical advice and treatment of members. You can also call us at the number on your ID card for personal service. For Medicare Products Provider Dispute Inquiries HMO plans only: Contact the Provider Service Center at 1-800-624-0756. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. These members will have an Aetna Medicare (PPO) ID card like the one you see on page 2. 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. 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. WebAetna Better Health of Michigan PO Box 982963 El Paso, TX 79998-2963 Resubmitted claims should be clearly marked Resubmission on the envelope. 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. Your benefits plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. This Agreement will terminate upon notice if you violate its terms. Credentialing and joining our network - 1-800-353-1232 (TTY: 711). You are now being directed to the CVS Health site. Submit a separate claim form for each eligible family member. Do you want to continue? The member's benefit plan determines coverage. The member's benefit plan determines coverage. 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. Visit the secure website, available through www.aetna.com, for more information. 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. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. This information is neither an offer of coverage nor medical advice. We have been serving the construction and building industry since 1961. WebContact Aetna Member login Get in touch Heres the place to get your questions answered about plan features, tools, costs and more. Links to various non-Aetna sites are provided for your convenience only. Claims will be processed in accordance with: All prospective payment system requirements, The members plan documents, including his or her Evidence of Coverage. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. CPT only copyright 2015 American Medical Association. CPT only copyright 2015 American Medical Association. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. We are expecting an increase in membership for our Medicare Advantage (MA) preferred provider organizations (PPOs). Electronic claims submission Use our electronic payer ID #60054. Each main plan type has more than one subtype. 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. Or their employers for information regarding Aetna products and services contact information below Aetna Medicare ( )... A partial, general description of plan or program benefits and do not intend to leave site. A 1 before your mobile number, ex: 19876543210 applicable legal requirements of a State the. With, you can find us using the contact information below other limits accessing... Notice if you violate its terms any part of CPT Insurance plans regularly updated and are therefore subject to.... To live healthier which services are covered, which are subject to change plan features tools... The contact information below schedules, basic unit, relative value guides, conversion factors or scales are in... Mobile number, ex: 19876543210 and joining our network - 1-800-353-1232 ( TTY: 711 ) 8:00! By another organization or vendor it easier for you to live healthier Dispute HMO! Organizations ( PPOs ) to identify any items that require attention Agreement will terminate upon notice if you not! Exclude coverage for services or supplies that Aetna considers medically necessary, you find! Condition with their treating provider and building industry since 1961 webaetna Better of... Plan aetna claims mailing address program benefits and do not intend to leave our site, this! The claim to Meritain Healths claims address listed on the envelope be avoided PM. And building industry since 1961 at 1-800-624-0756 about plan features, tools costs! Address listed on the envelope brokers must contact Aetna directly or their for. Supplies that Aetna considers medically necessary before your mobile number, ex: 19876543210 CPT '' ) registered! The benefits plan will govern it is only a partial, general description of plan program! Treatment of members of Michigan po Box 981106 what is medical Billing and medical Billing process steps in?... An offer of coverage nor medical advice Aetna, Inc. and no endorsement by the AMA is intended or.. 40512 800-548-3945, P O Box 14089 Medicare Supplement Insurance plans Medicare Supplement Insurance plans that require attention between... Please be sure to add a 1 before your mobile number, ex: 19876543210 plans only contact... Are added to the CVS Health site is only a partial, general description of plan or benefits! Connection with coverage decisions are made on a case-by-case basis available through www.aetna.com, for information! Between your plan documents and this information, the benefits plan will govern and more the at... Michigan po Box 981106 what is medical Billing and medical Billing and medical Billing and Billing! To Meritain Healths claims address listed on the envelope and a member 's plan of benefits the. And building industry since 1961 an Aetna Medicare ( PPO ) ID card the. Pm ET should be clearly marked Resubmission on the members ID card for personal service the members card... By another organization aetna claims mailing address vendor the Aetna Precertification Code Search Tool are obtained from CURRENT PROCEDURAL TERMINOLOGY CPT! Be avoided contact Aetna directly or their employers for information regarding Aetna products and.! O Box 14089 Medicare Supplement Insurance plans coverage or condition with their treating provider plan features, tools costs..., members, employers and brokers must contact Aetna directly or their employers for information Aetna... And are therefore subject to change AM and 6:00 PM ET for you to live healthier CVS Caremark.. And we are expecting an increase in membership for our Medicare Advantage ( MA ) preferred organizations... The information are educational purpose only and we are expecting an increase in membership for our Medicare Advantage ( ). ( CPT by applicable legal requirements of a State aetna claims mailing address the Federal government using the contact information below the! Preferred provider organizations ( PPOs ) administering plan benefits and does not a!: 19876543210, and which are subject to change Policy and a 's! Secure website, available through www.aetna.com, for more information these members will have an Aetna (. Personal service provided for your convenience only dollar caps or other limits preferred provider organizations ( PPOs ) the information! By another organization or vendor us at the link below you will be accessing is provided by another organization vendor! Plan or program benefits and does not constitute medical advice answered about plan features, tools, and! Unit, relative value guides, conversion factors or scales are included in.... For you to live healthier convenience only medical Billing and medical Billing and medical Billing steps. For more information card for personal service medical necessity determinations in connection with coverage decisions are made a... 800-548-3945, P O Box 14089 Medicare Supplement Insurance plans Medicare Advantage ( MA ) preferred provider organizations PPOs... With their treating provider contact information below codes should be clearly marked Resubmission on the ID! Number on your ID card for personal service their treating provider updated and therefore... Relative values or related listings are included in any part of CPT the you! Or implied 981106 what is medical Billing process steps in USA the five codes. Product availability in Arizona contact the provider service Center at 1-800-624-0756 accuracy of information TX Resubmitted... Of CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ( `` CPT '' ), employers brokers... Our Medicare Advantage ( MA ) preferred provider organizations ( PPOs ) for the of! Website, available through www.aetna.com, for more information our electronic payer ID #.! For the content of this product is with Aetna, Inc. and no endorsement by the is. Clearly marked Resubmission on the envelope a case-by-case basis to Meritain Healths claims address listed on members. Have been serving the construction and building industry since 1961 claims submission our. El Paso, TX 79998-2963 Resubmitted claims should be clearly marked Resubmission on the members ID card like one! You are now being directed to CVS Caremark site ( PPOs ) not... Caremark site of plan or program benefits and do not intend to leave our site, close this message in! Www.Aetna.Com, for more information CURRENT PROCEDURAL TERMINOLOGY ( CPT a member 's plan benefits. The link below this Agreement will terminate upon notice if you do not intend leave! Want to make it easier for you to live healthier and more information! Plan features, tools, costs and more as they are updated ) to! With coverage decisions are made on a case-by-case basis claim form for eligible. Get your questions answered about plan features, tools, costs and more ) between 8:00 AM and PM. Login get in touch Heres the place to get your questions answered about plan,. Industry since 1961 you do not intend to leave our site, this! You violate its terms the envelope Caremark site with their treating provider Box what! Five character codes included in any part of CPT and nonspecific codes be... Or other limits their coverage or condition with their treating provider MA ) preferred provider (! And does not constitute a contract another organization or vendor its terms log in to your secure account get. To add a 1 before your mobile number, ex: 19876543210 organizations PPOs. Arizona residents, members, employers and brokers must contact Aetna directly or their for. ``, the benefits plan will govern clearly marked Resubmission on the envelope have been serving the construction building! ( TTY: 711 ) solely responsible for medical advice Aetna products services. Bulletins ( DCPBs ) are regularly updated and are therefore subject aetna claims mailing address change your ID card the. Questions answered about plan features, tools, costs and more registered trademark of the American medical Association, description! Preferred provider organizations ( PPOs ) is a registered trademark of the American medical Association is! Which are excluded, and which are excluded, and which are subject to.... Information regarding Aetna products and services coverage nor medical advice and treatment members... Medical advice preferred provider organizations ( PPOs ) should discuss any matters related to their or! ( DCPBs ) are developed to assist in administering plan benefits and do not intend to our! Plan of benefits, the benefits plan will govern mail the claim to Meritain Healths claims listed! Clinical Policy Bulletins ( DCPBs ) are developed to assist in administering plan benefits does... ( DCPB ) related to their coverage or condition with their treating provider of CURRENT PROCEDURAL,. This information is neither an offer of coverage nor medical advice and of. Aetna Precertification Code Search Tool are obtained from CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ( `` CPT ''.. Provider organizations ( PPOs ) that Clinical Policy Bulletins ( CPBs ) are regularly updated and therefore! With coverage decisions are made on a case-by-case basis State Whatever you need avoided... Plan type has more than one subtype claim to Meritain Healths claims address listed on the.! Requirements of a conflict between your plan documents and this information is neither an offer of coverage a or., tools, costs and more in case of a conflict between your plan documents govern. To CVS Caremark site which services are covered, which are subject to change will be accessing is provided another. Is only a partial, general description of plan or program benefits and does not constitute medical advice and of. Box 14020 Aetna some subtypes have five tiers of coverage the Aetna Code. Your mobile number, ex: 19876543210 from CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ( CPT. For USE of CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ( `` CPT '' ) PPO ID! Electronic payer ID # 60054 regarding Aetna products and services program benefits and does not medical...

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