3/21/2023 0 Comments Aetna better health timely filingThe following are examples of acceptable proof of timely filing: If any of the scenarios listed below apply, but the claim in question is still within the 365-day window, a waiver is not needed and the provider only needs to resubmit the claim. How can a provider qualify for a timely waiver (override)? The previous ICN must be referenced on the claim, even if the claim is over 365 days. Providers must also resubmit claims every 60 days after the initial timely filing period (365 days from the DOS) to keep the claim within the timely filing period. What should providers do if the initial 365-day window for timely filing is expiring? Providers are required to submit the initial claim within 365 days, even if the result is a denial. What date is used when considering timely filing deadlines? A claim is considered filed when the fiscal agent documents receipt of the claim. A timely filing waiver or a previous Internal Control Number (ICN) is required if a claim is submitted beyond the 365-day timely filing period. Please note, these are mailed to the New Albany, Ohio address listed at the top of the form.What is the deadline for meeting timely filing requirements? Providers always have at least 365 days from the DOS to submit a claim. Federal regulations 42 CFR 42 § 422.504(g) requires us to protect Aetna Better Health members from financial liability, therefore, appeals must include a signed Waiver of Liability (WOL) form. You may submit an appeal for a claim denied based on error or absence of fact, except for timely filing. This requires the provider to fill out the non-PAR Provider Appeal Form: Once the provider has access, instructions for reconsideration thru the portal can be found here.Ĭlaim Reconsiderations for non-PAR providers (Appeal) - a claim for a non-contracted provider in which the provider is not correcting the claim in anyway, but disagrees with the original claim outcome and wishes to challenge the payment or denial of a claim. This requires the provider to request access to the portal. This requires the provider to fill out the PAR Provider Dispute Form:Īlternatively, a PAR provider can also submit a Reconsideration via the secure web portal for better convenience. Please note, claim resubmissions are mailed to the following address:Ĭlaim Reconsiderations for PAR providers (Dispute) – a claim for a PAR provider in which the provider is not correcting the claim in anyway, but disagrees with the original claim outcome and wishes to challenge the payment or denial of a claim. Paper claims should also have the word ‘RESUBMISSION’ written across the top of the claim. Resubmitted claims should be clearly marked “Resubmission” on the envelope.įor out-of-network providers seeking payment of claims for emergency, post-stabilization and other services authorized by us, please refer to the policies and procedures in the provider manual.Ĭlaim Resubmission (Corrected Claim) – a claim that is resubmitted to ABHO via the same process of a new day claim (via provider’s claims tool, Aetna’s claims portal, or mailed) but the claim itself has been corrected in some way and the claim is designated as ‘Corrected’ via Bill Type code. Or you can mail hard copy claims or resubmissions to:Īetna Better Health of Ohio (M圜are Ohio Program)
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