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. Torequest participation in First Health networks, follow the link below. Hartford, CT 06156 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. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. BOX 14586 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. Visit the secure website, available through www.aetna.com, for more information. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Call Aetna Mail Order Drug at 1-866-612-3862 (TTY: 711). Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Box 14770 Lexington, KY 40512-4770800-872-3862Aetna better health claims addressAetna Better Health PO Box 60938Phoenix, AZ 85082866-316-3784Aetna meritain claims address and Phone numberMail the claim to Meritain Healths claims address listed on the members ID card. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. The AMA is a third party beneficiary to this Agreement. PO Box 981106 WebMail Claims to: Aetna Pharmacy Management. Aetna The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. 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. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". WebContact Us Close Menu Contact Us Questions? 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 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. Applicable FARS/DFARS apply. This section relates to information about the patient. Some subtypes have five tiers of coverage. 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. 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. 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. Visit the secure website, available through www.aetna.com, for more information. 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. 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 questions on how to submit electronic claims to third-party administrators, such as an individual practice association, contact the third-party administrator. 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) 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. Before implement anything please do your own research. 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). 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 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. 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. NAIC Coordination of Benefits Policy. For current employers, health care professionals and producersget the Aetna logo. Precertification is recommended, but not required. 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. Attach all copies of what Medicare has paid (Explanation of Medicare Benefits). 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. USA. 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. LEXINGTON KY 40512-4586 888-632-3862, PO BOX 23759 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. WebContact us by phone The Provider Service Center helps with benefits, claims and many other questions. This Agreement will terminate upon notice if you violate its terms. This information is neither an offer of coverage nor medical advice. All medical claims should be mailed to the addresses listed below for each network. In all cases, the patient or authorized person must sign. Visit the secure website, available through www.aetna.com, for more information. 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. 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, 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. Aetna address and Aetna Provider Phone Number for Claims Complete list: Denials with solutions in Medical Billing, Denials Management Causes of denials and solution in medical billing, CO 4 Denial Code The procedure code is inconsistent with the modifier used or a required modifier is missing, CO 5 Denial Code The Procedure code/Bill Type is inconsistent with the Place of Service, CO 6 Denial Code The Procedure/revenue code is inconsistent with the patients age, CO 7 Denial Code The Procedure/revenue code is inconsistent with the patients gender, CO 15 Denial Code The authorization number is missing, invalid, or does not apply to the billed services or provider, CO 17 Denial Code Requested information was not provided or was insufficient/incomplete, CO 19 Denial Code This is a work-related injury/illness and thus the liability of the Workers Compensation Carrier, CO 23 Denial Code The impact of prior payer(s) adjudication including payments and/or adjustments, CO 31 Denial Code- Patient cannot be identified as our insured, CO 119 Denial Code Benefit maximum for this time period or occurrence has been reached or exhausted, Molina Healthcare Phone Number claims address of Medicare and Medicaid, Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit, Kaiser Permanente Phone Number Claims address and Timely Filing Limit, Amerihealth Caritas Phone Number, Payer ID and Claim address, ICD 10 Code for Sepsis Severe Sepsis and Septic shock with examples, Anthem Blue Cross Blue Shield Timely filing limit BCBS TFL List, Workers Compensation Insurances List of United States, Workers Compensation time limit for filing Claim and reporting in United States. Others have four tiers, three tiers or two tiers. With respect to bundling/unbundling logic, we use the Correct Coding Initiative (NCCI). 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 Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. If you missed Open Enrollment, 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. 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. * Need more help with electronic claims submissions? 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 860 262 9111. 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