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Claims

You can file claims with us electronically 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. 

 

Questions?

You can check your provider manual. Or just contact us.

Fee schedules and billing codes

 

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

 

Doula provider billing guide (PDF)

 

Provider reimbursement fee schedule

 

Durable medical equipment and supplies fee schedule

You’ll need to fill out a claim form.

 

You must file claims within 180 days of 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

 

You can submit claims or resubmissions online through ConnectCenter. This is our provider claims submission portal via Change Healthcare (formerly known as Emdeon). To register, visit the ConnectCenter portal and follow the prompts to “Enroll New Customer.”

 

ConnectCenter portal

 

ConnectCenter user guide (PDF)

 

Once you’ve submitted claims, you can visit the Provider Portal to review claims payment information.

 

Change Healthcare  

ChangeHealthcare.com  

1-866-371-9066

 

By mail

You can also mail hard copy claims or resubmissions to:

Aetna Better Health of Florida 

PO Box 982960 

El Paso, TX 79998-2960

 

Mark resubmitted claims clearly with “resubmission” to avoid denial as a duplicate.

You can resubmit a claim through ConnectCenter or by mail. If you resubmit through the ConnectCenter portal, you’ll need to mark your resubmission with a "7” in the indicator field. 

 

If you resubmit by mail, you’ll need to include these documents:

 

  • Claim adjustment request/claim reconsideration form (PDF)
  • 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

To learn more about claim appeals, just visit our complaints and appeals page.

 

Complaints and appeals

A claim reconsideration is a request that we previously received and processed as a clean claim.
 

When you send a reconsideration, be sure to include:

 

 

Be aware that we:

 

  • Process and decide claims within 30 days of receipt — This includes:

    • Completing the appeal and reprocessing
    • Processing clean payments for professional and institutional claim submissions
  • Process and decide claim reconsiderations within 120 days of the resolution date on the original (clean) claim’s EOB
  • Identify a Coordination of Benefit (COB) resubmission as a claim previously denied for other insurance info, or originally paid as primary without coordination of benefits
  • Process and decide COB claim reconsiderations within 95 days from the disposition date on the primary carrier’s EOB or response letter

 

We can’t accept COB reconsiderations via electronic transmission.

 

You can file a claim reconsideration by mail:


Mail your claim adjustment request/claim reconsideration form and all supporting documents to:

Aetna Better Health of Florida  

PO Box 982960 

El Paso, TX 79998-2960 

Electronic Funds Transfers (EFT) and Electronic Remittance Advise (ERA) Registration Services (EERS)

All ABHFL EFT/ERA Registration Services (EERS) are managed by Change Healthcare. EERS gives payees multiple ways to set up EFT and ERA in order to receive transactions from multiple payers.

Electronic funds transfer (EFT)

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

Electronic remittance advice (ERA)

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

How to enroll

To enroll in EFT/ERA Registration Services (EERS) visit Change Health payer enrollment services website 

 

  • Create your enrollment by filling out the Provider Information, Contact Information, Bank Information (only if adding EFT enrollment(s)), and Enrollment Information.
  • Submit your enrollment(s) and you will receive an email notification confirming submission to Change Healthcare.
  • Log in to the Provider Portal to check the status of your enrollment(s).

 

How to disenroll

 

Contact the Change Healthcare Support Team and let them know that you would like to withdraw an enrollment.

 

Change Healthcare’s Payer Enrollment Services FAQ

 

Change Healthcare Support Team can be contacted at 800-956-5190 Monday through Friday 8:00AM – 5:00PM CST.

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