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). The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. This Agreement will terminate upon notice if you violate its terms. 151 Farmington Avenue It is only a partial, general description of plan or program benefits and does not constitute a contract. Copyright 2015 by the American Society of Addiction Medicine. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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). Where to turn for help Depending on your situation, you have a variety of resources to help you find the answers youre looking for: Review reports promptly to identify any items that require attention. This is the phone number PO Box 398106. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 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). Boston, MA 02215-0014 Treating providers are solely responsible for medical advice and treatment of members. LEXINGTON KY 40512-4089 800-354-5835, PO BOX 14100 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. Payer ID 60054, PO BOX 569000 Reprinted with permission. This section relates to information about the covered person. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Aetna Medicare Grievance & Appeals 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. 1-866-604-7092, Aetna Medicare Prescription Drug Plan Applicable FARS/DFARS apply. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. No fee schedules, basic unit, relative values or related listings are included in CPT. Payer ID 60054 You are now being directed to CVS Caremark site. Treating providers are solely responsible for dental advice and treatment of members. Disclaimer of Warranties and Liabilities. Thanks, Coupon "NSingh10" for 10% Off onFind-A-CodePlans. Reimbursement and claims processing information. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Medicare limiting charges apply. CPT is a registered trademark of the American Medical Association. What is Medical Billing and Medical Billing process steps in USA? 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 Box 21542, Eagan, MN 55121 Phone: (800) 821-6136 Avoid the additional cost of submitting duplicate claims by using the Claim Status Inquiry to check the status of claims prior to resubmitting. Unlisted, unspecified and nonspecific codes should be avoided. 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. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. Be sure to have your student ID number. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. Correct rejected claims and resubmit electronically. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Aetna Aetna Claim Address & Phone No. 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. Links to various non-Aetna sites are provided for your convenience only. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Do not include any dashes, suffixes or spaces. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. The AMA is a third party beneficiary to this Agreement. WebAll dental claims should be submitted to EDI: 44054 If you do not have electronic claim submission capabilities, you can mail claims on standard HCFA, UB and dental claim forms. 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. 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. The AMA is a third party beneficiary to this Agreement. 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 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. No fee schedules, basic unit, relative values or related listings are included in CPT. WebContact Us Close Menu Contact Us Questions? The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Each main plan type has more than one subtype. NAIC Coordination of Benefits Policy. We are expecting an increase in membership for our Medicare Advantage (MA) preferred provider organizations (PPOs). CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Indicate which type of covered person you are. Do you want to continue? In all cases, the patient or authorized person must sign. The ABA Medical Necessity Guidedoes not constitute medical advice. 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). Call our If you find anything not as per policy. 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. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 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. PO Box 14079 PO Box 14079 Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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 responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Lexington, KY 40512, P O BOX 981109 EL PASO TX 79998-1109 800-777-3240, PO BOX 981107 EL PASO TX 79998-1107 800-245-1206, Aetna B,M ,W 888-632-3862 AL, AK, AR, AZ, CA, FL, GA, HI, ID, LA, MS, NC, NM, NV, OR, SC, UT, TN, WA, State Links to various non-Aetna sites are provided for your convenience only. The ABA Medical Necessity Guidedoes not constitute medical advice. 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. ICD 10 Code for Obesity| What is Obesity ? Have questions about our products, policies and services? While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. If you have any questions, please contact our Provider Service Center at the following: The Provider Service Center helps with benefits, claims and many other questions. All Rights Reserved to AMA. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. LEXINGTON KY 40512-4100 800-424-4047, PO BOX 14586 All Rights Reserved. For language services, please call the number on your member ID card and request an operator. 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. El Paso, TX 79998-1106. Aetna claims phone number: For Medical coverage decision Mailing Address: Medical Service: PO Box 14079 Lexington, KY 40512-4079 For Medical Appeal Mailing Address: Aetna Medicare Part C Appeal and Attachments arent necessary. Just log in to your member account to send us an email or chat online. 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. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. LA, MS, NC, NM, NV, OR, SC, UT, Chain or PSAO pharmacies can request to participate in our Part D retail pharmacy network by emailing us this information: E-mail your pharmacy information to Aetna. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 1-800-358-8749 (TTY: 711), Monday to Friday, 8 AM to Paper claims submission The ABA Medical Necessity Guidedoes not constitute medical advice. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Remember to include the patient-paid amount on claims and encounters submitted to us. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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 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. When billing, you must use the most appropriate code as of the effective date of the submission. 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.

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