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.
Medicaid Adult benefit package effective 4/27/15
Beginning April 27, 2015, all applicants 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
Information about payment by the Department of Human Services (DHS) Fee-For-Service for items not covered by the PCO
- 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.
HIPAA 5010 and ICD-10 Information - 10/1/2015
On January 15, 2009 the US Department of Health & Human Services issued two final rules for adoption:
- An updated HIPAA X12 standard version 5010 for electronic transactions, with a compliance date of January 1, 2012. The updated format has more than 1300 changes to the 4010 standard (with 600+ just for claims).
- Adoption of the ICD-10 Code Sets with a compliance date in October 2015 (version 5010 accommodates the ICD-10 code structure; 4010 does not).
Aetna Better Health met the compliance requirements for the federally mandated HIPAA 5010 version transactions for 1/1/2012 and is on track to be able to accept ICD-10-CM & PCS Codes for dates of service for October 2015.
Online ICD-10 Resources
- Road to 10: The Centers for Medicare and Medicaid Services (CMS) has created a website that's a great resource for small physician practices and specialty practices.
- Crosswalks for the Top 50 Codes by Specialty at the AAPC website
- 100 Tips for ICD-10-PCS Coding at icd10monitor.com
- Free code conversion tool from icd10monitor.com
- Quick tips for qualifiers from Pennsylvania's Department of Human Services (DHS)
Pennsylvania Medicaid EHR Incentive Program
The Medicaid Electronic Health Records Incentive Payment Program was created by the American Reinvestment and Recovery Act and administered by Centers for Medicare & Medicaid Services. This program provides funding to states to develop and administer provider incentive programs.
Click here to learn more about Pennsylvania’s Medical Assistance Health Information Technology Initiative.