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Claims

You can file claims with us online 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. 

 

Claims reference guide (PDF)

Questions?

You can check your provider manual (PDF). Or call Provider Relations at 1-866-638-1232 (TTY: 711). We’re here for you Monday through Friday, 8 AM to 5 PM.

You can check your provider manual (PDF). Or call Provider Relations at 1-866-638-1232 (TTY: 711). We’re here for you Monday through Friday, 8 AM to 5 PM.

Fee schedules and billing codes

 

You can find the billing codes you need for specific services on the fee schedules.

 

Fee schedule

  • You’ll need to fill out a claim form.

     

    You must file claims within one year 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 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 Aetna Better Health of Pennyslvania 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 Kids

    Claims Submissions

    PO Box 982973

    El Paso, TX 79998-2973

  • 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 (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

  • Both in-network and out-of-network providers have the right to appeal the result of a decision. You’ll want to file your appeal in writing within 60 calendar days of the reconsideration response (date of EOB).

     

    You'll get a final determination letter with the appeal decision, rationale and date of the decision. We usually resolve provider appeals within 60 calendar days.

     

    If the appeal decision isn’t in your favor, you can’t “balance bill” the member for services or payment that we denied for coverage. 

     

    Appeal form (PDF)

     

    You can file an appeal:

     

    By mail

    You can send your appeal to:

     

    Aetna Better Health Kids

    Attn: Appeals Department

    PO Box 81040 

    5801 Postal Road 

    Cleveland, OH 44181

     

    By fax
     

    Fax your appeal to 1-860-754-1757.

     

    Learn more about claim appeals

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. 

 

  • 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

  • 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.  

  • ECHO Health processes and distributes 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.

     

    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. 

     

    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 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

 

 

International Classification of Diseases (ICD-10) resources:

 

Also of interest: