Members should discuss any matters related to their coverage or condition with their treating provider. This search will use the five-tier subtype. 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). 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. CPT only Copyright 2022 American Medical Association. Links to various non-Aetna sites are provided for your convenience only. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Copyright 2015 by the American Society of Addiction Medicine. 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. In all cases, the patient or authorized person must sign. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. This is the phone number Copyright 2015 by the American Society of Addiction Medicine. All Rights Reserved. Aetna countered that statistic with its own, which says that 98% of Blue Cross NCs 2021 claims came from providers in Aetnas network. CPT only copyright 2015 American Medical Association. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. 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. AL, AK, AR, AZ, CA, FL, GA, HI, ID, 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. This information is neither an offer of coverage nor medical advice. You have options. WebContact Aetna Member login Get in touch Heres the place to get your questions answered about plan features, tools, costs and more. Lexington, KY PO Box 14079 All Rights Reserved. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). EL Paso , TX 79998-1204, Paper Claims HMO & PPO Products Mail claims to: Tampa Florida 33630 The member's benefit plan determines coverage. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. If payment is to be made DIRECTLY to the service provider (such as a doctor or hospital), also sign this block. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Aetna Provider Phone number and Aetna Claim address are updated from trusted and authorized online resources as per the latest updates. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. The information you will be accessing is provided by another organization or vendor. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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. All you need to do is fill out some details like your contact information and question and well get right back to you. Aetna Medicare Grievance & Appeals The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. CPT only copyright 2015 American Medical Association. Applicable FARS/DFARS apply. PO Box 15708 Designed by Elegant Themes | Powered by WordPress. PO BOX 981204 WebAll medical claims should be mailed to the addresses listed below for each network. A. Aetna Signature Administrators800-238-6288CoverMyMeds866-452-5017Coventry (workers comp and no-fault auto injury)800-937-6824Aetna medicare supplement claims addressAetna Senior Supplemental Insurance P.O. Hartford, CT 06156 Links to various non-Aetna sites are provided for your convenience only. You are now being directed to the CVS Health site. 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. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. You can also call us at the number on your ID card for personal service. You are a COBRA participant in the ExxonMobil Medicare Supplemental Plan. 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. D. Your signature is required to complete this form. LA, MS, NC, NM, NV, OR, SC, UT, Unlisted, unspecified and nonspecific codes should be avoided. 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. Call Aetna Mail Order Drug at 1-866-612-3862 (TTY: 711). 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. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Federal No Surprises Act. CPT only copyright 2015 American Medical Association. No fee schedules, basic unit, relative values or related listings are included in CPT. Aetna Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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. 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. CPT only Copyright 2022 American Medical Association. No fee schedules, basic unit, relative values or related listings are included in CPT. 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). If you missed Open Enrollment, The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Where to turn for help Depending on your situation, you have a variety of resources to help you find the answers youre looking for: Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". If they dont select a PCP, we may select one for them. Aetna Better Health of Kentuckys standard contacts are listed below: Aetna Better Health contacts Toll-free Fax Provider Services CICR (Claims Inquiry and claims research) 1-855-300-5528, 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, Care/Disease Management 1-888-470-0550 1-855-454-5044, Lock-In Program 1-855-300-5528 1-866-415-2818. 2. Avoid the additional cost of submitting duplicate claims by using the Claim Status Inquiry to check the status of claims prior to resubmitting. 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.) Should be mailed to the service provider ( such as a doctor or hospital,! 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