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Claims

You can file claims with Aetna Better Health® of Illinois online or through the mail. And we’ve streamlined processing and improved payment turnaround time so you can save time and effort.

You can submit a claim:

Online

Online

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

By mail

By mail

You can also mail hard copy claims or resubmissions to:

 

Aetna Better Health of Illinois
Claims and Resubmissions
PO Box 66545
Phoenix, AZ 85082

 

For resubmitted claims, add the word “resubmission” clearly on the claim form to avoid receiving a denial for a duplicate submission.

How do I file a claim?

How do I file a claim?

 

First, you need to fill out a claim form. 

 

You must file claims within 180 days from the date services were performed, 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 date of service or date of discharge to submit a revised version of a processed claim. This is called a “claim resubmission.” When you resubmit a claim, clearly write “resubmission” on the paper claim form. 

 

Electronic funds transfer (EFT)

EFT makes it possible for us to deposit electronic payments directly into your bank account. You can get an EFT form on our secure Provider Portal. Or download it below. Some of the benefits of setting up EFT include:

 

  • Improved payment consistency*

  • Fast, accurate and secure transactions*

  • Payments sent directly into your bank account

     

*Provider experiences may vary.

Electronic remittance advice (ERA)

ERA refers to an electronic file that contains claim payment and remittance information that was sent to your office. Sometimes, we’ll refer to ERA by its HIPAA transaction number: 835. You can get an ERA form on our Provider Portal. Or download it below. The benefits of ERA include:

 

  • Reduced manual posting of claim payment information, which saves you time and money, allowing you to more efficiently manage your resources

  • Elimination of the need for paper Explanation of Benefits (EOB) statements

How can I resubmit a claim?

A claim may be resubmitted if it was denied or incorrectly paid due to missing documentation or another processing error. You must clearly write “resubmission” on it and mail it with all the following: 

 

  • An updated copy of the claim — all lines must be rebilled

  • A copy of the original claim (a reprint or a copy is acceptable)

  • A copy of the remittance advice on which the claim was denied or incorrectly paid

  • A brief note describing the requested correction 

  • Any additional appropriate documentation 

 

If you resubmit through the WebConnect portal, you’ll need to identify your resubmission with a "7” indicator field. When submitting claims to our plan, use the provider ID number “68024” for both CMS-1500 and UB-04 forms.

Timely Filing

To be eligible for reimbursement, providers must file claims within a qualifying time limit. A claim will be considered for payment only if it is received by Aetna Better Health® of Illinois no later than 180 days from the date on which services or items are provided. This time limit applies to both initial and corrected claims.

 

Corrected claims, as well as initial claims, received more than 180 days from the date of service will not be paid.

 

A “request for reconsideration” must be submitted before a claim dispute. Requests for Reconsiderations must be submitted within 90 calendar days of the original determination or Explanation of Payment (EOP). Claim disputes must be received within 90 days of the reconsideration response date, not to exceed 1 year from the DOS.

 

When Aetna Better Health of Illinois is the secondary payer, claims must be received within 90 calendar days of the final determination of the primary payer.

For more information

Consult your provider manual (PDF). Or call us at 1-866-329-4701 (TTY: 711).