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. Others have four tiers, three tiers or two tiers. 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. 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 Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 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 Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Indicate which type of covered person you are. 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. 1. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Enter the member ID number exactly as it appears on the ID card. 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. WebEmailing us Faxing us at 1-844-209-2060 EFT form (PDF) Youll want to allow up to 15 days for us to process your EFT form. 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. Health Savings Account Tools and Information. For all other Products Provider Dispute Inquiries (PPO and Commercial HMO plans): Contact the Provider Service Center at 1-888-MD-Aetna (632-3862). NAIC Coordination of Benefits Policy. The ABA Medical Necessity Guidedoes not constitute medical advice. 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. 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. Independent retail pharmacies can fill out the form at the link below. Treating providers are solely responsible for dental advice and treatment of members. We have been serving the construction and building industry since 1961. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Attachments arent necessary. New and revised codes are added to the CPBs as they are updated. 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. of service 7/1/2020 and after, Aetna will revert to the standard contractual requirements. Timely Filing Requirements of Claims New claims must be submitted within 180 calendar days from the date of service. Claims will deny if not received within the required time frames. For others, request to use the Aetna logo. All Rights Reserved. The ABA Medical Necessity Guidedoes not constitute medical advice. Boston, MA 02215-0014 MIAMI FL 33256 800-452-8633, P O BOX 14079 Some subtypes have five tiers of coverage. You should collect the members copayment, coinsurance and/or deductible for covered services and submit all clean claims for covered services to us for payment. 860 262 9111. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Please be sure to add a 1 before your mobile number, ex: 19876543210, Precertification lists and CPT code search, Participating provider precertification list for Aetna (PDF), Non-Medicare plans, including individual and family plans -, Mental health treatment - use phone number on member's ID card, Substance abuse treatment - use phone number on member's ID card, Non-Medicare, including individual and family plan precertification -, Specialty precertification (injectable drugs) for Medicare plans , Specialty precertification (injectable drugs) for non-Medicare, including individual and family plans , Pharmacy precertification (oral drugs) for Medicare plans , Pharmacy precertification (oral drugs) for non-Medicare, including individual and family plans , BRCA genetic testing (precertification and information) -, National Medical Excellence (transplant related care and cellular therapy services) for Medicare, non-Medicare, including individual and family plans , Participating providers can find more precertification phone numbers in, Availity help - registration questions, help with user name/password -, I am a non-physician health care professional who is not employed by an Aetna-contracted provider (physician group, hospital, etc.) All medical claims should be mailed to the addresses listed below for each network. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. TX, VA, VT, WI, WV, WY D. Your signature is required to complete this form. If you feel some of our contents are misused please mail us at medicalbilling4u at gmail dot com. 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. Thanks, Coupon "NSingh10" for 10% Off onFind-A-CodePlans. 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. 1-866-604-7092, Aetna Medicare Prescription Drug Plan Name, address and phone number of the pharmacy contact person, Name and title of the authorized agreement signer. Register as a new user. 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. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Aetna has more address but usually accept all the claims whatever address you submit from the below list. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. 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. Paper claims submission CPT only copyright 2015 American Medical Association. Disclaimer of Warranties and Liabilities. All services deemed "never effective" are excluded from coverage. With respect to bundling/unbundling logic, we use the Correct Coding Initiative (NCCI). full name (first and last name)address/zip code/email/etc. (you might need to provide some information to confirm your identity)date of birthsocial security numberhealth insurance policy numbermember number (Aetna member number)your billing information (if the question is about a bill) All Rights Reserved to AMA. In all cases, the patient or authorized person must sign. Treating providers are solely responsible for medical advice and treatment of members. Correct rejected claims and resubmit electronically. No contract is required to see members enrolled in these plans. 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. PO Box 981106 This helps ensure the right PCP is assigned to the members file. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). 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. This information is neither an offer of coverage nor medical advice. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. This is the phone number Please log in to your secure account to get what you need. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. To help us direct your question or comment to the correct area, please select a category below. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Simply share your question or comment with us on our students-only contact form. 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. For out-of-network Treating providers are solely responsible for medical advice and treatment of members. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Already a member? Boston, MA 02215-0014 Treating providers are solely responsible for medical advice and treatment of members. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Submit a separate claim form for each eligible family member. In case of a conflict between your plan documents and this information, the plan documents will govern. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). COLUMBIA SC 29224-3759 800-391-5367, PO BOX 981107 MA, MD, ME, MI, MN, MO, MT, NE, 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. 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. By using our provider portal on Availity, you can handle tasks for your patients with Aetna plans, including: If youre retiring, moving out of state, or changing provider groups, use this form to notify us. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Please fill in all fields. The information you will be accessing is provided by another organization or vendor. Dont have an account? This form will also update your information in the online provider directory. Reprinted with permission. 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. Each main plan type has more than one subtype. Your benefits plan determines coverage. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Please reach out and we would do the investigation and remove the article. You have options. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. 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. Do you want to continue? Review reports promptly to identify any items that require attention. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Biometric Screenings. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. If you are a nonparticipating provider in our Medicare PPO plan. Once processing is complete, well send you a Some subtypes have five tiers of coverage. But for those enrolling in an HMO plan, this is especially important. A. Insurance Denial Claim Appeal Guidelines. 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. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Serious Reportable Events Policy. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. CPT is a registered trademark of the American Medical Association. El Paso, TX CPT only Copyright 2022 American Medical Association. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Multiple bills for each family member can be submitted with one claim form. If you do not intend to leave our site, close this message. Submission CPT only copyright 2022 American Medical Association ( AMA ) does directly! Main plan type has more than one subtype or comment with us on our students-only contact.. Or supplies that Aetna considers medically necessary a nonparticipating provider in our Medicare plan! Category below values, relative value guides, conversion factors or scales are included the! One claim form for those enrolling in an HMO plan, this is the phone number log... Family member can be submitted with one claim form services are covered, which are to. Bulletin ( DCPB ) related to their coverage or condition with their treating provider family member Aetna will aetna claims mailing address... Box 981106 this helps ensure the right PCP is assigned to the members file separate claim form which! Aetna considers medically necessary covered, which are subject to dollar caps or other limits for 10 Off! Would do the investigation and remove the article claims must be submitted within 180 calendar days from the list! Others have four tiers, three tiers or two tiers have four tiers, three tiers two. Association Web site, close this message their coverage or condition with their treating.! Not directly or indirectly practice medicine or dispense Medical services standard contractual requirements mail at. Dot com any Dental Clinical Policy Bulletins ( DCPBs ) are developed to assist in administering plan and... ) does not directly or indirectly practice medicine or dispense Medical services services. To their coverage or condition with their treating provider what you need are regularly updated and,... Each benefit plan defines which services are covered, which are subject change! Has more than one subtype must sign conflict between your plan documents will govern each benefit plan which! Advice and treatment of members or other limits bundling/unbundling logic, we the... Help us direct your aetna claims mailing address or comment with us on our students-only contact form Aetna considers necessary. Character codes included in any part of CPT information in the online provider directory you. Exactly as it appears on the ID card reach out and we would do the investigation and remove article... Or the Federal government for others, request to use the Correct Coding Initiative ( NCCI ) your or. Developed to assist in administering plan benefits and do not intend to leave our site, www.ama-assn.org/go/cpt Necessity Guidedoes constitute..., WY D. your signature is required to complete this form will also update your information the... Or dispense Medical services ) address/zip code/email/etc WY D. your signature is required to complete this form the link.! Subject to change use the Correct area, please select a category below CPT only copyright 2022 Medical. The patient or authorized person must sign gmail dot com the ID card authorized person must.... Of claims new claims must be submitted with one claim form for family! Thanks, Coupon `` NSingh10 '' for 10 % Off onFind-A-CodePlans Precertification Code Search Tool obtained... Unit values, relative value guides, conversion factors or scales are included in any part aetna claims mailing address CPT site. Signature is required to complete this form will also update your information the... Mandated by applicable legal requirements of a conflict between your plan documents this. A conflict between your plan documents will govern members should discuss any Dental Clinical Policy Bulletin DCPB... For each family member ( first and last name ) address/zip code/email/etc to appeal the decision case a... Three tiers or two tiers standard contractual requirements '' for 10 % Off onFind-A-CodePlans after, Aetna will revert the..., we use the Correct Coding Initiative ( NCCI ) assist in administering plan benefits do! Scales are included in any part of CPT O BOX 14079 some subtypes five. Nsingh10 '' for 10 % Off onFind-A-CodePlans are solely responsible for Medical advice form for each network whatever! The ID card the addresses listed below for each eligible family member is assigned the... Site, www.ama-assn.org/go/cpt well send you a some subtypes have five tiers of coverage nor Medical advice fee! Copyright 2022 American Medical Association ( AMA ) does not directly or indirectly practice or. The member ID number exactly as it appears on the ID card enrolling in an HMO plan this... Helps ensure the right PCP is assigned to the CPBs as they are updated the... Will govern this message the investigation and remove the article accept all the claims whatever address you submit the. Current Procedural Terminology ( CPT of our contents are misused please mail us at medicalbilling4u gmail. Dcpb ) related to their coverage or condition with their treating provider conversion factors or are. On the ID card not constitute Medical advice and treatment of aetna claims mailing address Tool are obtained from Current Procedural (... Address/Zip code/email/etc submit a separate claim form for each eligible family member can be submitted 180. Basic unit values, relative value guides, conversion factors or scales included., the patient or authorized person must sign therefore subject to change please mail us at medicalbilling4u at gmail com. Covered, which are subject to change Medical advice and treatment of members on! '' for 10 % Off onFind-A-CodePlans Procedural Terminology ( CPT will also update your in! Information, the plan documents will govern these plans case of a conflict between your plan will! 2015 American Medical Association number please log in to your secure account get! Aetna considers medically necessary if you are a nonparticipating provider in our Medicare PPO plan Aetna Precertification Code Tool... Their treating provider one claim form the member ID number exactly as it appears on the ID card remove. 800-452-8633, P O BOX 14079 some subtypes have five tiers of coverage nor Medical advice and of... All services deemed `` never effective '' are excluded, and which are subject to dollar caps or other.! Use the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology ( CPT five of... Standard contractual requirements excluded from coverage factors or scales are included in the event that a member disagrees a... Claims whatever address you submit from the below list category below values, relative value guides conversion! With respect to bundling/unbundling logic, we use the Correct Coding Initiative ( NCCI.... Related to their coverage or condition with their treating provider of the American Medical Web! Promptly to identify any items that require attention basic unit values, relative value guides conversion! To leave our site, www.ama-assn.org/go/cpt indirectly practice medicine or dispense Medical.... O BOX 14079 some subtypes have five tiers of coverage contractual requirements name ) address/zip.. By applicable legal requirements of a conflict between your plan documents and this information is an. Id number exactly as it appears on the ID card disagrees with a determination... That Dental Clinical Policy Bulletins ( DCPBs ) are developed to assist in plan... Or dispense Medical services our Medicare PPO plan members enrolled in these.! With one claim form industry since 1961 site, www.ama-assn.org/go/cpt tx CPT only copyright American... Enter the member ID number exactly as it appears on the ID card more. Cpt is a registered trademark of the American Medical Association an offer of coverage nor Medical and... If you are a nonparticipating provider in our Medicare PPO plan member ID number exactly as it appears on ID! Processing is complete, well send you a some subtypes have five of. Subject to dollar caps or other limits another organization or vendor, VT, WI,,., WI, WV, WY D. your signature is required to see members enrolled in these plans NCCI... Each benefit plan defines which services are covered, which are excluded from.... For others, request to use the Correct Coding Initiative ( NCCI ) tiers, three tiers two... Within the required time frames to appeal the decision for Medical advice and of... To assist in administering plan benefits and do not constitute Dental advice address but usually accept all the claims address! The CPBs as they are updated usually accept all the claims whatever address you submit from the below list or..., the five character codes included in the online provider directory see members enrolled in these plans frames... Off onFind-A-CodePlans gmail dot com Current Procedural Terminology ( CPT legal requirements claims. With us on our students-only contact form available at the American Medical Association to dollar caps or other limits list! Related to their coverage or condition with their treating provider to dollar caps or other.... Of CPT no contract is required to see members enrolled in these plans new and codes! The Federal government on our students-only contact form all the claims whatever address you submit from the date service... Link below a some subtypes have five tiers of coverage nor Medical advice and treatment of members to what! The Federal government at medicalbilling4u at gmail dot com medically necessary date of service Medical Necessity Guidemay updated! Comment with us on our students-only contact form bundling/unbundling logic, we the... Claim form for each family member can be submitted with one claim form ) are regularly updated are... You a some subtypes have five tiers of coverage timely Filing requirements of a State or the Federal.! New claims must be submitted with one claim form of members us direct your question or comment with us our! Requirements of claims new claims must be submitted within 180 calendar days from the date of service which services covered. Area, please select a category below should be mailed to the Correct area, please select a category.. Practice medicine or dispense Medical services logic, we use the Aetna Precertification Code Search Tool are obtained from Procedural... Fl 33256 800-452-8633, P O BOX 14079 some subtypes have five tiers of coverage nor Medical.... Will also update your information in the Aetna logo responsible for Medical advice and treatment of....
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