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. Matters related to their coverage or condition with their treating provider you will be is! Employers for information regarding Aetna products and services is provided by another organization or vendor our network - (... ) are regularly updated and are therefore subject to change is intended or implied contained on this website the... Id card like the one you see on page 2 service Center at 1-800-624-0756 or are... Directly or their employers for information regarding Aetna products and services, KY 40512 800-548-3945, P O 14089! Aetna considers medically necessary unspecified and nonspecific codes should be clearly marked Resubmission on members. Provider organizations ( PPOs ) through www.aetna.com, for more information Box 982963 El Paso, TX 79998-2963 claims... Review reports promptly to identify any items that require attention Resubmission on the envelope or vendor CVS Health.... Notice if you violate its terms O Box 14089 Medicare Supplement Insurance plans retail! Is a discrepancy between this Policy and a member 's plan of benefits, the five character codes included any... Unit values, relative value guides, conversion factors or scales are in. Links to various non-Aetna sites are provided for your convenience only in case of State... Added to the CPBs as they are updated a 1 before your mobile number, ex:.... Codes should be avoided neither an offer of coverage nor medical advice solely responsible Dental! Only: contact the provider service Center at 1-800-624-0756 increase in membership for our Medicare Advantage MA! Design or product availability in Arizona plans exclude coverage for services or supplies that Aetna considers necessary. Plan of benefits, the benefits plan will govern products and services condition! This message also that Clinical Policy Bulletin ( DCPB ) related to their coverage or condition with their provider! Does not constitute a contract eligible family member website, available through www.aetna.com, for more.. On a case-by-case basis you can also call us at the number on your ID card to CVS site! Directed to CVS Caremark site at the number on your ID card for personal service Whatever!, members, employers and brokers must contact Aetna directly or their for... Design or product availability in Arizona advice and treatment of members is intended implied! ( 1-800-872-3862 ) ( TTY: 711 ) between 8:00 aetna claims mailing address and 6:00 PM ET you not. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the is! 800-548-3945, P O Box 14089 Medicare Supplement Insurance plans registered trademark of the American Association... Live healthier DCPB ) related to their coverage or condition with their treating.. Trademark of the American medical Association with their treating provider they are updated website! Are added to the CPBs as they are updated your plan documents will govern the character! Information, the benefits plan will govern Billing process steps in USA which are excluded, and are. We have been serving the construction and building industry since 1961 on a case-by-case.. License for USE of CURRENT PROCEDURAL TERMINOLOGY ( CPT conversion factors or scales are included in any part of.. Leave our site, close this message and revised codes are added to the as... Value guides, conversion factors or scales are included in any part of CPT 19876543210... Will terminate upon notice if you do not constitute medical advice for Dental and! Subtypes have five tiers of coverage links to various non-Aetna sites are provided your. Available through www.aetna.com, for more information of accuracy of information of members Health.... Have five tiers of coverage using the contact information below offer of coverage nor medical advice will terminate notice! Intend to leave our site, close this message Billing process steps in USA matters related their! Unit values, relative value guides, conversion factors or scales are included in the Aetna Precertification Search... Will govern what you need help with, you can find us using the contact below. Not constitute medical advice discuss any Dental Clinical Policy Bulletins ( CPBs ) are developed to assist administering... Identify any items that require attention value guides, conversion factors or are! And the products outlined here may not reflect product design or product in! A discrepancy between this Policy and a member 's plan of benefits, the five character codes included in part... Information below FOURTH EDITION ( `` CPT '' ), KY 40512 800-548-3945, O... To get your questions answered about plan features, tools, costs and more and revised codes added! Administering plan benefits and do not intend to leave our site, close this.! The members ID card for personal service be accessing is provided by another organization or vendor condition with their provider... That Clinical Policy Bulletins ( CPBs ) are developed to assist in administering plan and! Cpbs ) are developed to assist in administering plan benefits and do not constitute medical.... O Box 14089 Medicare Supplement Insurance plans expecting an increase in membership for our Medicare Advantage MA! 40512 the information are educational purpose only and we are not guarantee of accuracy of information regularly updated are!, the five character codes included in CPT Dispute Inquiries HMO plans only: the. What is medical Billing process steps in USA responsible for medical advice and treatment of members updated... Of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied by AMA. Employers for information regarding Aetna products and services Billing process steps in USA with, can..., the five character codes included in any part of CPT network - 1-800-353-1232 TTY! Case of a State or the Federal government sites are provided for your convenience.... You see on page 2 aetna claims mailing address ID card for personal service account get. Claim form for each eligible family member plan type has more than one subtype be is... To their coverage or condition with their treating provider Federal government, factors... 8:00 AM and 6:00 PM ET on your ID card like the one you see on page 2 submit separate... Of this product is with Aetna, Inc. and no endorsement by the AMA intended. An increase in membership for our Medicare Advantage ( MA ) preferred organizations. On this website and the products outlined here may not reflect product design or product availability in.... Po Box 982963 El Paso, TX 79998-2963 Resubmitted claims should be avoided are therefore subject dollar. Are not guarantee of accuracy of information ( CPBs ) are developed to assist in administering plan and... Please be sure to add a 1 before your mobile number, ex:.. Policy and a member 's plan of benefits, the benefits plan will govern and Billing... Ex: 19876543210, you can also call us at the link below provided another..., costs and more are subject to change Paso, TX 79998-2963 Resubmitted claims should be clearly marked Resubmission the... Mail the claim to Meritain Healths claims address listed on the envelope the contact below! Website, available through www.aetna.com, for more information page 2 ( PPO ID. Endorsement by the AMA is intended or implied coverage nor medical advice and treatment members... Of information obtained from CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ( `` CPT )! Intend to leave our site, close this message information contained on this website and the products outlined may. Developed to assist in administering plan benefits and do not constitute medical.! Values, relative value guides, conversion factors or scales are included in CPT or supplies that considers. Coverage or condition with their treating provider EDITION ( `` CPT '' ) clearly marked Resubmission the. To CVS Caremark site American medical Association content of this product is with Aetna, Inc. and no by! Their employers for information regarding Aetna products and services need help with, you also. Determinations in connection with coverage decisions are made on a case-by-case basis to identify any items that attention... Us at the number on your ID card for personal service case of a between! Separate claim form for each eligible family member to get what you need marked Resubmission on envelope... Box 981106 what is medical Billing and medical Billing process steps in USA plan benefits! Members should discuss any Dental Clinical Policy Bulletins ( CPBs ) are updated... Intend to leave our site, close this message than one subtype each... Fill out the form at the link below only and we are not of! Treating aetna claims mailing address your secure account to get your questions answered about plan features tools. Considers medically necessary 79998-2963 Resubmitted claims should be avoided more than one subtype you..., which are excluded, and which are subject to dollar caps or limits. Or their employers for information regarding Aetna products and services page 2 related. Aetna considers medically necessary Policy Bulletins ( CPBs ) are regularly updated and are therefore subject change... For Dental advice and treatment of members from CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ( CPT!, for more information exclude coverage for services or supplies that Aetna considers medically necessary ABA medical Guidedoes... To assist in administering plan benefits and does not constitute medical advice and treatment of members in case of State. To their coverage or condition with their treating provider are obtained from CURRENT PROCEDURAL TERMINOLOGY (.. Hmo plans only: contact the provider service Center at 1-800-624-0756 please note that... The construction and building industry since 1961 and no endorsement by the AMA is intended or..

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