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.
Important DHS training invitation for PROMISe providers and new providers
In preparation to launch the secure electronic provider enrollment portal for the PROMISe provider community, DHS invites providers to attend internet virtual classroom training.
The training session is designed to educate new providers wishing to enroll, and existing enrolled providers wishing to revalidate, in the PA Medical Assistance program on the secure electronic provider application system. The electronic provider enrollment user interface will allow providers to complete their enrollment application online, effective January 29, 2016.
DHS encourages providers who need to revalidate by March 24, 2016, to submit revalidation applications as soon as possible.
As of 1/19/16, 68% of service locations have revalidated. Approximately 55,000 additional service locations need to revalidate by the March 24th deadline. Please do not wait for the electronic application to submit your revalidation application.
You can register for any of the following training sessions by clicking here.
- Monday, January 25, 2016 – 9:00 to 11:00 a.m.
- Monday, January 25, 2016 – 1:00 to 3:00 p.m.
- Tuesday, January 26, 2016 – 9:00 to 11:00 a.m.
- Tuesday, January 26, 2016 – 1:00 to 3:00 p.m.
- Wednesday, January 27, 2016– 9:00 to 11:00 a.m.
- Wednesday, January 27, 2016 – 1:00 to 3:00 p.m.
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.
CHIP benefit changes effective 12/1/2015
On August 20, 2015, Governor Tom Wolf announced that all CHIP health insurance plans would provide enhanced benefits. The added benefits are outlined in the Affordable Care Act. These benefits take effect for all children enrolled in CHIP on December 1, 2015.
- To see Governor Wolf’s announcement, go to http://bit.ly/1JeHA1b
- To access the Pennsylvania Insurance Department’s CHIP website go to http://www.chipcoverspakids.com/
These changes include removing some historical benefit limits on specific services to ensure Minimal Essential Coverage (MEC) compliance for all CHIP Products.
Some categorical benefit changes include:
- Increasing vision services to include low vision items and “add-on” services such as protective coating, when medically necessary.
- Adding sealants to the dental benefit package
- Ensuring parity in the number of behavioral health visits without limit
- Increasing outpatient rehabilitation visit limits to 30 per modality per benefit year (PT, OT, ST)
- Dollar limits for autism services have been removed
- Coverage for a home health visit when discharged from the hospital for a delivery or mastectomy
For a full list of changes, please see the updated CHIP member handbook on our website.
There is nothing current Aetna CHIP members need to do to get these benefits
All Aetna CHIP members will automatically receive these enhanced health benefits. Members will not receive new ID cards as the benefits are now MEC required for all Free, Low and Full Cost CHIP products by all CHIP contractors in the Commonwealth of Pennsylvania.
If Aetna CHIP members have any questions, they can call us at 1-800-822-2447. We’re here Monday to Friday, 8:00 a.m. to 5:00 p.m. TTY users please call 1-800-628-3323.
If you have any questions on these changes please contact Provider Relations at 1-866-638-1232, option 3.
Provider Reports Management Tool now available
We are pleased to inform you that your Quality Measurement Reports are now available online. You may now access year-to-date reports through the Provider Reports Management Tool on our secure web portal.
Some examples of the types of reports you can access include:
- HEDIS Gaps-in-Care Reports
- Pay-for-Performance Measure Reports
These reports serve as a guide for which Aetna Better Health members need care and where your practice stands regarding Pay-for-Quality incentives for the care you provide.
Be sure you receive credit for the care you provide to Aetna Better Health members
Pay-for-Quality is awarded for care captured administratively through claims submissions.
If you have provided care that we may not have captured due to potential claims or coding issues, please contact Aetna Better Health Provider Relations at 1-866-638-1232, option 3. You can also directly contact the Quality Translator that has been sending you Gaps-in-Care Reports for assistance.
As a reminder, you can access up-to-date panel lists for your practices on our secure web portal. You can also upload Medical Records for HEDIS Medical Record Review.
If your practice is not registered for the secure web portal or the Member Care Information portal, just complete and fax the registration form to Provider Relations at 1-860-607-7485.
The registration form can be found here.