AETNA Billing Address
Aetna has more address but usually accept all the claims whatever address you submit from the below list. Get the electronic payor id for Faster process. #60054 would be the payor id for most of the clearing house however double confirm the same with your clearing house.
Medical benefit claim submission
PO BOX 981204
EL Paso , TX 79998-1204
Paper Claims – HMO & PPO Products – Mail claims to:
Aetna
P.O. Box 14079
Lexington, KY 40512-4079
State
AL, AK, AR, AZ, CA, FL, GA, HI, ID,
LA, MS, NC, NM, NV, OR, SC, UT,
TN, WA
Address
Aetna
PO Box 14079
Lexington, KY
40512-4079
State
CO, CT, DC, DE, IA, IL, IN, KS, KY,
MA, MD, ME, MI, MN, MO, MT, NE,
ND, NH, NJ, NY, OH, OK, PA, RI, SD,
TX, VA, VT, WI, WV, WY
Address
Aetna
PO Box 981106
El Paso, TX
79998-1106
Aetna Student HealthSM
PO Box 15708
Boston, MA 02215-0014
Payer ID — 60054
PO BOX 569000
MIAMI FL 33256 800-452-8633
P O BOX 14079
LEXINGTON KY 40512 800-548-3945
P O BOX 14089
LEXINGTON KY 40512-4089 800-354-5835
PO BOX 14100
LEXINGTON KY 40512-4100 800-424-4047
PO BOX 14586
LEXINGTON KY 40512-4586 888-632-3862
PO BOX 3500
RICHMOND KY 40475
PO BOX 23759
COLUMBIA SC 29224-3759 800-391-5367
PO BOX 981107
EL PASO TX 79998 800-223-3580
Claims Inquiries – To confirm the recorded date of claims receipt or to make other inquiries about claims, you may call Aetna at 1-800-624-0756 for Medicare HMO Products / 1-888-MD-Aetna (632-3862) for All Other Products, or contact your clearinghouse vendor.
For Medicare Products Provider Dispute Inquiries HMO plans only: Contact the Provider Service Center at 1-800-624-0756. For all other Products’ Provider Dispute Inquiries (PPO and Commercial HMO plans): Contact the Provider Service Center at 1-888-MD-Aetna (632-3862).
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.
If you have any questions, please contact our Provider Service Center at the following:
For Medicare HMO plans only: 1-800-624-0756; For all other plans (PPO and Commercial HMO plans): 1-888 MD-Aetna (632-3862); Or visit the Aetna website at www.aetna.com.
Special notice for providers not accepting new patients: What to do if you’re contacted by a member or potential member If you’re 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:
** Aetna at 1-800-325-6541 for help; and
** The California Department of Managed Health Care at 1-888-466-2219, or the California Department of
Insurance at 1-800-927-4357, as applicable, to report any inaccuracy with !etna’s provider directory.
Aetna Medicare Grivance submission address
A grievance is a type of complaint you make about us or one of our network providers or pharmacies, including a complaint concerning the quality of your care. This type of complaint does not involve coverage or payment determinations. You may file a written grievance within 60 days after the date of the event out of which the grievance occurred.
Aetna Medicare Advantage PlanU
Aetna Medicare Grievance & Appeals
PO Box 14067
Lexington, KY 40512
Fax Number:
1-866-604-7092
Aetna Medicare Prescription Drug Plan
Aetna Medicare Grievance & Appeals
PO Box 14579
Lexington, KY 40512
Fax Number:
1-866-604-7092
AETNA CHOICE POS
P O BOX 981109 EL PASO TX 79998-1109 800-777-3240
AETNA MEDICARE
PO BOX 981107 EL PASO TX 79998-1107 800-245-1206
Genral phone numbers
Aetna B,M ,W 888-632-3862
Aetna HMO 800-624-0756
Aetna Global Benefits (Middle East) LLC
PO BOX 6380
Dubai, UAE
Aetna International
PO BOX 30545
Tampa Florida 33630
860 262 9111
Aetna Better Health of Kentucky’s standard contacts are listed below:
Aetna Better Health contacts Toll-free Fax Provider Services CICR (Claims Inquiry and claims research) 1-855-300-5528
Member Services 1-855-300-5528
Pharmacy 1-855-300-5528 1-855-799-2550
Behavioral Health 1-888-604-6106 1-855-301-1564
Retrospective Review 1-888-470-0550, #4, #3, #7 1-855-336-6054
Concurrent Review 1-888-470-0550, #4, #3, #6 1-855-454-5043
Prior Authorization – Medical 1-888-725-4969 1-855-454-5579
Prior Authorization – Behavioral Health 1-888-604-6106 1-855-301-1564
Prior Authorization – Pharmacy 1-855-300-5528 1-855-799-2550
Provider Relations 1-855-454-0061 1-855-454-5584
Appeals 1-855-300-5528 1-855-454-5585
Care/Disease Management 1-888-470-0550 1-855-454-5044
Lock-In Program 1-855-300-5528 1-866-415-2818
HOW TO COMPLETE THIS FORM
A. This section relates to information about the covered person.
• Provide the name, Member ID number or Social Security number, address and phone number of the covered person.
• Indicate which type of covered person you are.
• You are the covered person if:
– 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
– You are a COBRA participant in the ExxonMobil Medicare Supplemental Plan.
B. This section relates to information about the patient.
• Provide the patient’s name, relationship to the covered person, Member ID number or Social Security number, sex and date of birth.
C. This section must be completed.
D. Your signature is required to complete this form.
1. In all cases, the patient or authorized person must sign.
2. If payment is to be made DIRECTLY to the service provider (such as a doctor or hospital), also sign this block.
HOW TO FILE A CLAIM
Because this plan supplements Medicare, Aetna cannot process your claim for expenses covered by Medicare unless you have first filed with Medicare and received an Explanation of Medicare Benefits.
In order to file a claim:
• Submit a separate claim form for each eligible family member. Multiple bills for each family member can be submitted with one claim form.
• Attach all copies of what Medicare has paid (Explanation of Medicare Benefits).
• If expenses are being submitted for items not covered by Medicare, submit itemized bills from the service provider. When you have all the information necessary, mail your claim to the Aetna office shown on the top of this form.
BE SURE TO KEEP COPIES OF CLAIMS SUBMITTED FOR YOUR FILES
MAIL CLAIMS TO:
AETNA
P.O. BOX 14586
LEXINGTON, KY 40512-4586
Payer – Aetna
Attachment
Fax Number – 859-455-8650
Attachment Mailing Address – PO Box 981106
El Paso, TX 79998-1106
Appeals
Fax Number – 859-455-8650
Appeals Mailing Address – Provider Resolution Team
PO Box 14020
Lexington, KY 40512
We are expecting an increase in membership for our Medicare Advantage (MA) preferred provider organizations (PPOs).
As a result, you are likely to see more patients with these health plans.
Here’s what you need to know:
• 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.
• These MA PPO plans provide all the benefits of Original Medicare and more, such as unlimited hospitalization and coverage for certain preventive services.
• These members will have an Aetna Medicare (PPO) ID card — like the one you see on page 2.
If you are a nonparticipating provider in our Medicare PPO plan
• No contract is required to see members enrolled in these plans.
• 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 member’s MA PPO plan.
Limiting charges apply.
• Simplified billing — submit one bill to Aetna and receive one remittance.
• No referrals are required to see members enrolled in these plans.
• Precertification is recommended, but not required.
• ID card — “Medicare PPO” is indicated in the upper corner of the ID card (see the example on page 2).
Electronic claims submission Use our electronic payer ID #60054.
Paper claims submission
Mail to:
Aetna
PO Box 981106
El Paso, TX 79998-1106
Submit all paper claims for covered services as soon as possible using an Aetna claims form or by using the standard CMS-1500 or UB-04 form.
Finding correct claim submission address based on state
•Enter the member ID number exactly as it appears on the ID card. Do not include any dashes, suffixes or spaces.
•Review reports promptly to identify any items that require attention.
•Correct rejected claims and resubmit electronically.
•All providers, both participating and nonparticipating, can submit claims electronically regardless of patient’s benefits plan.
•Avoid the additional cost of submitting duplicate claims by using the Claim Status Inquiry to check the status of claims prior to resubmitting.
•Attachments aren’t necessary. We’ll contact you if we need additional documentation.
•For questions on how to submit electronic claims to third-party administrators, such as an individual practice association, contact the third-party administrator.
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:
State
AL, AK, AR, AZ, CA, FL, GA, HI, ID, LA, MS, NC, NM, NV, OR, SC, UT, TN, WA
Address
Aetna
PO Box 14079
Lexington, KY
40512-4079
State
CO, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD, ME, MI, MN, MO, MT, NE, ND, NH, NJ, NY, OH, OK, PA, RI, SD, TX, VA, VT, WI, WV, WY
Address
Aetna
PO Box 981106
El Paso, TX
79998-1106
Aetna Student HealthSM
PO Box 15708
Boston, MA 02215-0014
Payer ID — 60054
Affordable HealthChoices from Aetna®
SRC, an Aetna company
PO Box 14079
Lexington, KY 40512-4079
Payer ID — 57604
Requirements to submit Coordination of Benefits (COB) claims electronically
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.
•Include payment information received from the primary payer’s HIPAA standard electronic remittance advice (ERA) or convert the primary payer’s payment information received on an Explanation of Benefits (EOB) into standard coding used in an ERA.
To learn more about submitting COB claims electronically, go to www.aetna.com/provider/ecob.
Where to turn for help Depending on your situation, you have a variety of resources to help you find the answers you’re looking for:
•If your claim rejects at the vendor level, contact your vendor.
•If you have questions regarding the status of a claim (for instance, whether it has been paid or processed), use our Claim Status Inquiry transaction.
•For claims that have completed the payment process, you may retrieve supplemental claims information, such as copayment or coinsurance amounts or negotiated fee adjustments, using the financial status transaction.* Need more help with electronic claims submissions? Use the Contact Us link on our website at www.aetna.com. Or, call your vendor’s customer service help line.
Reimbursement and claims processing information
You should collect the member’s copayment, coinsurance and/or deductible for covered services and submit all clean claims for covered services to us for payment. Remember to include the patient-paid amount on claims and encounters submitted to us. Claims will be processed in accordance with:
• Original Medicare billing rules
• Medicare fee schedule
• All prospective payment system requirements
• Local coverage determinations
• The member’s plan documents, including his or her Evidence of Coverage
Medicare limiting charges apply. With respect to bundling/unbundling logic, we use the Correct Coding Initiative (NCCI). The link to NCCI on the Centers for Medicare & Medicaid Services (CMS) website is www.cms.gov/nationalcorrectcodinited/.
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. Once logged in, under “Plan Central,”
select “Aetna Health Plan,” then “Support Center” from the menu bar on the left. 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.
You can visit www.aetnaeducation.com for easy access to training and resources related to MA plans. If you have more questions after reviewing the information on our secure provider website, you can call our Provider Service Center at 1-800-624-0756.
Aetna Enrollment
A complete application is the first step in the enrollment process When assisting your clients with their application, you’re responsible for answering their questions and ensuring all required information on the enrollment form is complete. If an application is submitted without all of the required information, this will cause a processing delay
Make sure the following items are included on all applications:
• Beneficiary’s name, as shown on their Medicare card
• Beneficiary’s date of birth
• Beneficiary’s permanent residence address/physical street address (PO box is not acceptable)
• Medicare HICN — this is the number on the beneficiary’s Medicare card
• Proof of Medicare Part A and/or B entitlement
• Requested effective date
• Plan selection
• Method of payment
• Signature(s) and date
• On all 2018 applications, your National Producer Number (NPN)*
Don’t forget to include the primary care physician (PCP) on the enrollment application We encourage all applicants to select a PCP when enrolling for a plan. But for those enrolling in an HMO plan, this is especially important. If they don’t select a PCP, we may select one for them. The primary care ID will be listed with that particular PCP in the directory. This helps ensure the right PCP is assigned to the member’s file. Please help ensure your clients don’t miss this critical step!
Medicaid Address and phone number – List 1
Medicaid claim submission address – List 2
