Together, we can improve health care quality
At Aetna Better Health of Pennsylvania, we value our provider partners. We want to make it easy for you to care for our members and guide them down the path to better health.
Please start by reading our provider manual. If you aren’t yet a contracted provider, learn more about joining our network. We also have information about clinical practices, all of the forms and resources you need, as well as the latest provider news and notices.
Our network providers and other health care providers are our partners in the delivery of high-quality health care services to our members. Good communication is the key to this successful partnership. Please take a minute to review our Medicaid quick reference guide.
Provider Relations Representatives
We're here to help.
You can contact your provider relations representative to help with your health plan needs. He or she can schedule a visit to answer questions about:
- health plan initiatives like pay-for-performance
- web portal navigation
- and more!
Contact our provider relations department at 1-866-638-1232 for more information.
Healthy PA Private Coverage Option
Aetna Better Health and Healthy PA Private Coverage Option – providing more people access to care
Our family of health care offerings has grown! We’re pleased to announce that beginning January 1, 2015, Aetna Better Health will participate with Pennsylvania’s new Healthy PA Private Coverage Option (PCO) in these Pennsylvania counties:
Working closely with you, our Aetna Better Health providers, we aim to deliver the same quality and accessible health care benefits and services to all of our members – traditional Medicaid, CHIP, and now, Healthy PA PCO members. Pennsylvanians ages 21-64 can find more about enrolling and choosing a PCO here.
Medicaid Adult benefit package effective 4/27/15
Beginning April 27, 2015, allapplicants eligible for Medical Assistance (MA) in the traditional adult Medicaid population will receive the new Medicaid Adult benefit package and be enrolled in a HealthChoices benefit plan. This transition will happen in two phases.
Please note: There will be overlapping eligibility from the Phase 1 and Phase 2 dates of transition until the Private Coverage Option (PCO) recipient is moved from the PCO.
The overlapping dates are:
- Phase 1: April 27 – May 31, 2015
- Phase 2: July 27 – August 31, 2015
Aetna Better Health remittance advice code M16
As instructed by your remittance advice by code M16, please see the below information regarding payment by the Department of Human Services (DHS) Fee-For-Service for items not covered by the PCO:
The PCO is the primary payer in this situation.
- A Third Party Liability (TPL) record will be created to cover the overlapping period to ensure the PCO is billed for covered services prior to the provider seeking payment from MA via PROMISe™.
- TPL records will be systematically generated with begin and end effective dates to align with the overlapping period.
- The MA FFS program is responsible for payment of eligible services not covered by the PCOs for the overlapping period (such as dental services).
Posted below are DHS training and informational guide to help providers, business and community partners during the transition to the new HealthChoices Expansion Program. Be sure to visit www.HealthChoicesPA.com frequently for up-to-date information about HealthChoices Expansion.
- HealthChoices Transition Guide
- Benefit Package Structure Changes
- Benefit Package Coverage and Limits
- Continuity of Care
- Health Screenings
- Understanding the Eligibility Verification System (EVS)
- HealthChoices Resources-Links