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 American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. You can also call your insurance companys member services (their phone number is on the back of your insurance card). To learn more about submitting COB claims electronically, go to www.aetna.com/provider/ecob. Just log in to your member account to send us an email or chat online. Find a seminar Extra benefits From a 24-hour nurse line to vision and In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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. No fee schedules, basic unit, relative values or related listings are included in CPT. Aetna Provider Phone number and Aetna Claim address are updated from trusted and authorized online resources as per the latest updates. Mail to: WebTo learn more about Aetna Senior Supplemental Insurance and our products, you can call, email or write us. To help us direct your question or comment to the correct area, please select from oneof the categories below. 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. CPT only copyright 2015 American Medical Association. 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. P.O. 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. 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. 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. Tampa Florida 33630 I am a non-physician health care professional who wants to be available for selection as a primary care provider (PCP), and my state regulations allow me to serve as a PCP. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. 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 dental claims should be mailed to GEHA at the appropriate address below: Direct Care Broker or Supplier Contracts EDI Submitter: 44054 P.O. Hartford, CT 06156 You are now being directed to CVS Caremark site. 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. Heres the place to get your questions answered about plan features, tools, costs and more. 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. Treating providers are solely responsible for medical advice and treatment of members. The primary care ID will be listed with that particular PCP in the directory. PO Box 14579 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Email, call or chat with Box 21542, Eagan, MN 55121 Phone: (800) 821-6136 Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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. 1-866-604-7092, Aetna Medicare Prescription Drug Plan 79998-1106, Aetna Student HealthSM Do you want to continue? Treating providers are solely responsible for medical advice and treatment of members. Please be sure to add a 1 before your mobile number, ex: 19876543210. LEXINGTON KY 40512-4100 800-424-4047, PO BOX 14586 Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). WebClaims - if you have questions about claims, contact the Provider Service Center (see list below) Credentialing - 1-800-353-1232 (TTY: 711) Dental providers - 1-800-451-7715 BE SURE TO KEEP COPIES OF CLAIMS SUBMITTED FOR YOUR FILES, MAIL CLAIMS TO: 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. Call Aetna Mail Order Drug at 1-866-612-3862 (TTY: 711). All you need to do is fill out some details like your contact information and question and well get right back to you. 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. Phone: 800 264.4000. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. Aetna has more address but usually accept all the claims whatever address you submit from the below list. If you are an Aetna member with questions about your coverage, please refer to our Member Services page for login information and additional ways to contact us. 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. You are now being directed to the CVS Health site. Provide the patients name, relationship to the covered person, Member ID number or Social Security number, sex and date of birth. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. The member's benefit plan determines coverage. You have options. We will pay Medicare-allowable rates to you for clean claims for covered services, less the member copayment, coinsurance and/or deductible, as described and required under MA regulations and the members MA PPO plan. Attach all copies of what Medicare has paid (Explanation of Medicare Benefits). The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. MIAMI FL 33256 800-452-8633, P O BOX 14079 Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. Next, select Doing Business with Us, then Aetna Benefit Products, then Aetna Medicare. To verify eligibility, click on the Eligibility tab on the Plan Central page. ND, NH, NJ, NY, OH, OK, PA, RI, SD, No contract is required to see members enrolled in these plans. ICD 10 code for Arthritis |Arthritis Symptoms (2023), ICD 10 Code for Dehydration |ICD Codes Dehydration, ICD 10 code Anemia |Diagnosis code for Anemia (2023). If they dont select a PCP, we may select one for them. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Submit a separate claim form for each eligible family member. They do not have access to member accounts but they can provide Aetna Member Services contact information. PO Box 14079 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. 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. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. WebTo contact our local staff, call 671-472-3862 or email GovGuamServices@aetna.com from 8AM5PM (MondayThursday), 9AM5PM (Friday). If you have questions related to COVID-19, including those on our telemedicine policy, testing, coding for COVID-19 related visits, and additional resources Aetna is sharing to support you during this pandemic, please check our Provider COVID-19 FAQ website. 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 AMA is a third party beneficiary to this Agreement. 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. PO BOX 981204 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. The link to NCCI on the Centers for Medicare & Medicaid Services (CMS) website is www.cms.gov/nationalcorrectcodinited/. Treating providers are solely responsible for dental advice and treatment of members. 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. In all cases, the patient or authorized person must sign. Please log in to your secure account to get what you need. P.O. LEXINGTON KY 40512-4586 888-632-3862, PO BOX 23759 Links to various non-Aetna sites are provided for your convenience only. El Paso, TX No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. CPT is a registered trademark of the American Medical Association. 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. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. LEXINGTON KY 40512-4089 800-354-5835, PO BOX 14100 Aetna Medicare Grivance submission address. 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. WebForms and Resources. 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. Listed with that particular PCP in the directory to member accounts but they can provide Aetna member contact! Has paid ( Explanation of Medicare Benefits ), 9AM5PM ( Friday ) Health site factors. Insurance companys member services contact information Business with us, then Aetna Benefit products then! Number aetna claims mailing address Social Security number, ex: 19876543210 all you need to do fill... ( CPBs ) are regularly updated and are therefore subject to change medical.. Address but usually accept all the claims whatever address you submit from the below.... Number, ex: 19876543210 Order Drug at 1-866-612-3862 ( TTY: 711 ) but accept... 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