Reclamos
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.
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Fee schedules and billing codes
You can find the billing codes you need for specific services in the fee schedules.
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You’ll need to fill out a claim form.
You must file claims within 180 days from the date you provided services, unless there’s a contractual exception. For inpatient claims, the date of service refers to the member’s discharge date. You have 180 days from the paid date to resubmit a revised version of a processed claim.
Online
Availity es nuestro portal para proveedores, que ofrece funcionalidades para el control de pacientes, reclamaciones, autorizaciones y remisiones. Para enviar reclamaciones en línea a través de Availity, seleccione el botón “Medicaid Claim Submission – Office Ally” (Envío de reclamaciones de Medicaid – Office Ally). Este enlace lo llevará directamente al sitio web de Office Ally, donde podrá presentar reclamaciones utilizando su función de ingreso de reclamaciones en línea o cargando un archivo de reclamación.
Providers must have an Office Ally account to submit claims online. The status of claims submitted online should be managed through your Office Ally Account.
Por correo
También puede enviarnos una copia impresa de sus reclamaciones o reenvíos por correo postal a:
Aetna Better Health of Illinois
Claims and Resubmissions
PO Box 982970
El Paso, TX 79998Mark resubmitted claims clearly with “resubmission” to avoid denial as a duplicate.
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You can resubmit a claim through Availity 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 (a reprint or a copy is acceptable)
- A copy of the remittance advice on which the claim was denied or incorrectly paid
- A brief note describing the requested correction
- Any additional appropriate documentation
Servicios de registro para EFT/ERA (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.
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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
- Transacciones rápidas, precisas y seguras
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 es necesario recibir la Explicación de beneficios (EOB) en papel
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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.
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ECHO Health processes and distributes Aetna Better Health claims payments to providers. To enroll in EERS, visit the Aetna Better Health ECHO portal. You can manage electronic funds transfer (EFT) and electronic remittance advice (ERA) enrollments with multiple payers on a single platform.
Regístrese para EFT
Para registrarse en la transferencia electrónica de fondos (EFT), deberá proporcionar un número de giro bancario de ECHO y el monto del pago por motivos de seguridad, como parte del proceso de autenticación. Encontrará el número de giro bancario de ECHO en todas las Explicaciones de pagos a proveedores (EPP), por lo general encima de su primera reclamación en el EPP. ¿Aún no ha recibido ningún pago de ECHO? Recibirá un cheque en papel con un número de giro que podrá utilizar para registrarse después de recibir su primer pago.
Actualice sus preferencias de pago o distribución de aviso de pago electrónico (ERA)
You can update your preferences on the dedicated Aetna Better Health ECHO portal.
Utilice nuestro portal para evitar tarifas
Se aplican tarifas cuando decide inscribirse en el programa de la cámara de compensación automatizada (ACH) para todos los pagadores de ECHO. Asegúrese de utilizar el portal de ECHO de Aetna Better Health para que el procesamiento no tenga tarifas. Puede confirmar que se encuentra en nuestro portal cuando vea “Aetna Better Health” en la parte superior izquierda de la página.
Tenga en cuenta que puede haber un retraso de 48 horas entre el momento en que recibe un pago y el momento en que el ERA está disponible.
Timely filing
To be eligible for reimbursement, providers must file claims within a qualifying time limit. A claim will be considered for payment only if it is received by Aetna Better Health® of Illinois no later than 180 days from the date on which services or items are provided. This time limit applies to both initial and corrected claims.
Corrected claims, as well as initial claims, received more than 180 days from the date of service will not be paid.
A “request for reconsideration” must be submitted before a claim dispute. Requests for Reconsiderations must be submitted within 90 calendar days of the original determination or Explanation of Payment (EOP). Claim disputes must be received within 90 days of the reconsideration response date, not to exceed 1 year from the DOS.
When Aetna Better Health of Illinois is the secondary payer, claims must be received within 90 calendar days of the final determination of the primary payer.
Helpful resources
Recursos de ECHO
- ECHO companion document (PDF)
- ECHO enrollment form (PDF)
- ECHO payments innovation for health plans (PDF)
- ECHO portal guide (PDF)
- ECHO frequently asked questions from providers (PDF)
Other resources
- Centers for Medicare & Medicaid Services (CMS) ICD-10 resources
- Conversion tool for Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to ICD-10 (PDF)
For more information
Consult your provider manual (PDF). Or call us at 1-866-329-4701 (TTY: 711).