Claims

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How to file a claim

You can file claims with us electronically or through the mail. We work to streamline the way we process claims. And improve payment turnaround time, so you can save time and effort.

You’ll want to use this Submitter ID number when you submit claims: Submitter ID# 26337 for both CMS-1500 sample (PDF) PDF Opens In New Window and UB-04 sample (PDF) PDF Opens In New Window forms.

Check the policies and procedures in the provider manual PDF Opens In New Window if you’re an out-of-network provider seeking payment of claims for services we cover, such as emergency care, post-stabilization and other services.

Online

Availity Opens In New Window is our provider portal, which provides functionality for the management of patients, claims, authorizations and referrals. To submit claims online via Availity, choose the button labeled “Medicaid Claim Submission – Office Ally.” This link will take you directly to the Office Ally website where you can submit claims using their online claim entry feature or by uploading a claim file.

Providers must have an Office Ally account to submit claims online. Submission of your claims using Office Ally is free of charge. The status of claims submitted online should be managed through your Office Ally Account.

By mail

You can also mail hard copy claims or resubmissions to:

Aetna Better Health Premier Plan MMAI
PO Box 982970
El Paso, TX 79998-2970

Mark resubmitted claims clearly with “resubmission” to avoid denial as a duplicate. 

How to file a claim resubmission (correction) or claim reconsideration (appeal/dispute)

Claim resubmissions

You can resubmit (correct) a claim through Availity Opens In New Window or by mail. If you resubmit by mail, you’ll need to include these documents:

• An updated copy of the claim — all lines must be rebilled
• A copy of the original claim (reprint or copy is acceptable)
• A copy of the remittance advice on which we denied or incorrectly paid the claim
• A brief note describing the requested correction
• Any other required documents

Mail resubmissions to:

Aetna Better Health Premier Plan MMAI
PO Box 982970
El Paso, TX 79998-2974

Mark resubmitted claims clearly with “resubmission” to avoid denial as a duplicate. 

Claim reconsiderations for PAR providers (dispute) and non-PAR providers (appeal)

A claim reconsideration is a request that we previously received and processed as a clean claim. With this process, you’re not correcting the claim in any way, like the claim resubmission process. Instead, you disagree with the original claim outcome and want to challenge the payment or denial of a claim.  

PAR providers can submit a claim reconsideration through Availity, our provider portal. Learn how to access the portal and submit and claim reconsideration.  

When you send a reconsideration, be sure to include:

• A claim form for each reconsideration
• A copy of the remit/Explanation of Benefits (EOB) page for each resubmitted claim, with a brief note about each claim you’re resubmitting
• Any information that we previously requested

Both PAR providers and non-PAR providers can file a claim reconsideration:

• Network providers use the PAR Provider Dispute Form (PDF) PDF Opens In New Window
• Nonparticipating providers use the non-PAR Provider Appeal Form (PDF) PDF Opens In New Window

You can submit an appeal for a claim we denied based on error or absence of fact, except for timely filing. Federal regulations 42 CFR 42 § 422.504(g) require us to protect members from financial liability. So you’ll want to include a signed Waiver of Liability (WOL) form (PDF) PDF Opens In New Window with your appeal.

 

 

EFT/ERA Registration Services (EERS)

EERS offers our providers a more streamlined way to access payment services. It gives you a standardized method of electronic payment and remittance while also expediting the payee enrollment and verification process.

More about EFT and ERA

EFT makes it possible for us to deposit electronic payments directly into your bank account. Some benefits of setting up an EFT include:

• Improved payment consistency
• Fast, accurate and secure transactions

ERA is an electronic file that contains claim payment and remittance info sent to your office. The benefits of an ERA include:

• Reduced manual posting of claim payment info, which saves you time and money, while improving efficiency
• No need for paper Explanation of Benefits (EOB) statements

How does EERS work?

EERS offers payees multiple ways to set up EFT and ERA in order to receive transactions from multiple payers. If a provider’s tax identification number (TIN) is active in multiple states, a single registration will auto-enroll the payee for multiple payers. You can also complete registration using a national provider identifier (NPI) for payment across multiple accounts. 

How and when do I enroll?

ECHO Health processes and distribute claims payments to providers. To enroll in EERS, visit the Aetna Better Health ECHO portal Opens In New Window. You can manage electronic funds transfer (EFT) and electronic remittance advice (ERA) enrollments with multiple payers on a single platform.

Sign up for EFT

To sign up for EFT, you’ll need to provide an ECHO payment draft number and payment amount for security reasons as part of the enrollment authentication. Find the ECHO draft number on all provider Explanation of Provider Payments (EPP), typically above your first claim on the EPP. Haven’t received a payment from ECHO before? You’ll receive a paper check with a draft number you can use to register after receiving your first payment.

Update your payment or ERA distribution preferences

You can update your preferences on the dedicated Aetna Better Health ECHO portal Opens In New Window.

Use our portal to avoid fees

Fees apply when you choose to enroll in ECHO’s ACH all payer program. Be sure to use the Aetna Better Health ECHO portal Opens In New Window for no-fee processing. You can confirm you’re on our portal when you see “Aetna Better Health” at the top left of the page.

Be aware — you may see a 48-hour delay between the time you receive a payment, and an ERA is available.

 

 

Helpful resources

ECHO resources

ECHO companion document (PDF) PDF Opens In New Window

ECHO enrollment form (PDF) PDF Opens In New Window

ECHO payments innovation for health plans (PDF) PDF Opens In New Window

ECHO portal guide (PDF) PDF Opens In New Window

ECHO frequently asked questions from providers (PDF) PDF Opens In New Window

International Classification of Diseases (ICD-10) resources

Centers for Medicare & Medicaid Services (CMS) ICD-10 resources Opens In New Window

Conversion tool for Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to ICD-10 (PDF) PDF Opens In New Window