Ndezvipi Zvokurapa Zvinoda Kuziva NezveAetna

Maitiro Ekutumira Zvikwereti kune Uyu Inshuwaridzi

Aetna inopa zvirongwa zvakasiyana-siyana zvehutano inshuwarisi, kusanganisira iyo yevanhu uye yebasa-inoronga zvirongwa. Vashandi vezvokurapa vangangodaro vanoda ruzivo rwekuti vangabhadhara sei uye vanoita zvayo kune iyo inshuwarisi. Heino zveruzivo pamusoro pemabasa avo.

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Zvose Zveruzivo pamusoro peAetna yeBhizinesi Bhidha

Bata Numeri

• Zvirwere uye Utano Hwehutano: Nezvirongwa zveHMO-based uye Medicare Advantage, danai 1-800-624-0756. Nezvimwe zvirongwa zvose, danai 1-888-MD-Aetna (1-888-632-3862).
• Aetna Pharmacy Management: 1-800-238-6279
• Dental providers: 1-800-451-7715
• Credentialing kana re-credentialing status: 1-800-353-1232

Address Information
Aetna Inc.
151 Farmington Avenue
Hartford, CT 06156

Web Address
www.aetna.com/healthcare-professionals

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Aetna Eligibility, Zvipo uye Mamiriro Ekutaura

Electronic Real-Time Eligibility (RTE)

• Inowanika maawa makumi maviri nemazuva, mazuva manomwe pavhiki
• Inowanikwa kuti iite chikamu uye isingatarisi vatapi vezvehutano
• Inokubvumira kuti upe mvumo yekubvunza mibvunzo kusvika kumwedzi gumi nemasere isati yasvika

Kukodzera, zvibatsiro uye mamiriro ekutaura zvinogona kuvimbiswa nenzira mbiri:

1. Kuburikidza neAetna yakachengeteka mupiro webhusaiti neNaviNet®, inowanika kuburikidza ne www.aetna.com/healthcare-professionals
2. Achishandisa mutengesi wemagetsi / kuchenesa

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Nzira Yokutumira A Precertification Chikumbiro cheAetna

Tumira precertification zvikumbiro usati wapihwa mazano kuburikidza nekushandurana kwemashoko emagetsi (EDI), kuburikidza ne www.aetna.com/healthcare-professionals kana nekufona uchishandisa nhamba yefoni padhigiramu yekuziva.

Nzira dzepamusoro nehutano pa prepretification list dzinogona kutora chiziviso uye / kana kusarudza kutsvaga.

• Precertification Code Tsvaga Chimbo

1. Pinda magwaro eCPT kuti uone kana precert ichidiwa

• Electronic Precertification

1. Inowanika maawa 24 pazuva, Muvhuro kusvika Mugovera
2. Gamuchira nhamba yeZvoiti yeZvoti
3. Kuzviisa kunorega kunopiwa huwandu hunotevera hwekutevera

Zvimwe

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Mashoko Okubhadhara Aetna

Pane nzira nhatu dzekutsvaga zvirevo kuna Aetna:

1. Kudavira komutambo kunogona kutumirwa kuburikidza newebsite yeAetna yakachengeteka yepaiti neNaviNet®, inowanika kuburikidza ne www.aetna.com/healthcare-professionals.
2. Zvitongwa zvemagetsi zvinogona kutumirwa kuburikidza nemutengesi wemagetsi / kuchenesa.
3. Pepanhau rinogona kuendeswa kuAetna kudai kero yekuteeresa yakanyorwa pane kadhi yeAdhi yemunhu.

Secondary claims:

• Tumira magetsi
• Itai kuti kugadziriswa zviyero - pamatanho maviri ekutaura uye nhare yemutambo (kana iripo)
• Itai zvikonzero zvekugadziriswa - zvibvumirano zvekubvumirana, kubhadharwa, kubhadhara, nekudaro. Shandisai mitsara inopiwa nemutengo wekubhadhara mubhadharo
• Mubhadharo wepamusoro unobhadharwa - pazvikwata zviviri zvekuda uye nheyo yepamusoro webasa (kana iripo).

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Zvirongwa Zvokudhinda Zvenguva Ino

Kunze kwekuti mutemo wemutemo kana chimwe chikamu chinoshanda:

1. Vanachiremba vane mazuva makumi mapfumbamwe kubva pazuva rebasa kuti vape mvumo yekubhadhara.
2. Zvipatara zvine gore rimwe kubva pazuva rebasa rekupa chikwata chekubhadhara.

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Corrected Claims

Paunenge uchiita shanduko kune zvikwereti zvekare zvakabhadharwa, tumira zvinoruramiswa zvirevo zvemagetsi. Dzorerai Frequency Code yekuda ne:
7 = Kuchinjwa kwechimbichimbi
8 = Kuwanikwa / kukweta kwezvakaitwa kare

Paunenge uchiita shanduko kune izvo zvataurwa kare zvakaramba, tumira zvinotsigirwa pamapepa:

1. Chidhindo "CHIMWE CHOKWADI" pamusoro pekutsvaga
2. Mail kune:
   Aetna
   PO Box 14079
   Lexington, KY 40512-4079

Zvimwe

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Kudzorera

Tumira kururamiswa kudai uye Aetna achadzorera / kudzosera kubhadharwa kuripo kuchazobvunzwa pane ERA ine kuchinja kwechikonzero chisina kukodzera kupiwa mhosva, inoteverwa nemhosva yakagadziriswa yemhosva.

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Aetna Claim Appeal Information

Kudzokorora

1. Mukati pemazuva makumi mapfumbamwe emakarani ekutanga kutora chirevo
2. Mumazuva mashanu ebhizinesi rekugamuchira chikumbiro. Mumazuva makumi matatu emabhizimisi ekugamuchira chikumbiro kana kuongororwa neunyanzvi hunodiwa hunoshandiswa (somuenzaniso, kugadziriswa kwekodini yekuongorora
3. Dana 1-800-624-0756 nokuda kwezvirongwa zveHMO-based benefits uye yeWam Primary Choice mapurogiramu kana kudana 1-888-632-3862 yezvipo uye zvipo zvePPO-based benefits
4. Mazita ekutumira mazita:
   
   States
   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
   States
   CO, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD, ME, MI, M, MO, MT, NE, ND, NH, NJ, NY, OH, OK, SD, TX, VA, VT, WI, WV, WY
   Address
   Aetna PO Box 981106 El Paso, TX 79998-1106
5. Tumira paIndaneti kuburikidza neEOB yekutsvaga tsvakurudzo. Ingoenda kune webhusaiti yakachengetedza webhusaiti kuburikidza neNaviNet® kuti uwane iyo shanduro.

Nhamba 1 Chikumbiro

1. Mumazuva makumi matanhatu ekurenda kwechigadziro chekufungisisa zvakare
2. Mumazuva makumi matatu emabhizimisi ekugamuchira chikumbiro. Kana humwe humwe ruzivo rudikanwa, pasati mazuva makumi matatu ebhizimisi rekugamuchira mamwe mazano akavakirwa
3. Dana 1-800-624-0756 nokuda kwezvirongwa zveHMO-based benefits uye yeWam Primary Choice mapurogiramu kana kudana 1-888-632-3862 yezvipo uye zvipo zvePPO-based benefits
4. Nyora Aetna Provider Resolution Team PO Box 14020 Lexington, KY 40512

Nhamba 2 Chikwata (chinowanikwa kune vashandi chete)

1. Mumazuva makumi matanhatu ekurenda kweChirungu 1 chisarudzo
2. Mumazuva makumi matatu emabhizimisi ekugamuchira chikumbiro. Kana humwe humwe ruzivo rudikanwa, pasati mazuva makumi matatu ebhizimisi rekugamuchira mamwe mazano akavakirwa
3. Dana 1-800-624-0756 nokuda kwezvirongwa zveHMO-based benefits uye yeWam Primary Choice mapurogiramu kana kudana 1-888-632-3862 yezvipo uye zvipo zvePPO-based benefits
4. Nyora Aetna Provider Resolution Team PO Box 14020 Lexington, KY 40512

Zvimwe