Long Term Care Facility Billing Changes
Aetna Better Health is in the process of updating our payment systems to be compliant with the 12-1-2016 Long Term Care Facility Billing Changes set forth by HFS. Providers should continue to bill claims with the appropriate billing instructions consistent with the date of service. Please click here for more information.
Weekend Utilization Management Policy
We are writing to inform you of a policy change related to our "Weekend Utilization Management Policy" that was implemented in July 2016. Aetna Better Health of Illinois has heard your feedback and we are adjusting the policy based on your suggestions. Click here for more information on this policy.
Updating the Provider Directory Survey
As part of our ongoing effort to report accurate and complete information in our directory, your office was identified as missing hours of operation information. This information is required by CMS and the Illinois Department of Healthcare and Family Services for each provider in our directory. We are requesting that you take a moment to provide this information for your location(s).
- Fill out the survey for your locations, indicating your office details and the hours of operation.
General Acute Care and Children’s Billing Guidelines 11/10/2016
General Acute Care and Childrens Hospital Billing Guidelines
The Illinois Department of Healthcare and Family Services (HFS) requires Managed Care Organizations (MCO) to meet very specific claim data submission standards requiring particular and exact data elements on claims submitted from Hospitals. To facilitate the appropriate application of these rules, Managed Care Organizations are collectively relaying the enclosed information in this Provider Memorandum in an effort to reiterate and provide transparency on hospital billing guidelines for services rendered in a Children’s and General Acute Care Institutional setting. Please click here to read the offical memorandum.
Click here for the General Acute Care and Children’s Billing Guidelines.
Medicare Prescriber Enrollment
Beginning 2/1/2017, Aetna Better Health will require prescribing providers to be either enrolled in Medicare fee-for-service or have a valid opt-out affidavit on file effective Feb 1st, 2017. Starting on February 1st, 2017, MMAI members will obtain a provisional supply when filling prescriptions written by prescribers who do not meet the above requirement.
For additional information visit the CMS provider and supplier enrollment page.
Any additional information related to the above notice can be directed to the provider services at Aetna Better Health.
HFS Issuing DASA Billing Guidance
Aetna Better Health of Illinois DASA Webinar and conference calls are as follows:
Webinar- Wednesday, August 10th at 11:00 a.m.
First conference call- Wednesday, August 17th TBD
Second conference call- Wednesday, September, 17th TBD
Keeping Medicare Advantage directory information up to date
The Centers for Medicare & Medicaid Services (CMS) requires all Medicare Advantage organizations to contact you at least quarterly to confirm that the information in our directory is accurate. This includes:
- Ability to accept new patients
- Street address
- Phone number
- Any other changes that affect availability to patients
If you notify us of any changes, we have 30 days to update our online directory.
For more information, refer to this fact sheet.
The Council for Affordable Quality Healthcare® (CAQH) helps meet this need
CAQH has a unique solution to ensure that directory information is accurate. They developed it with our help and that of other health plans. CAQH’s directory confirmation process uses data from your CAQH ProView ™profile. You simply review, update and confirm your information in ProView. Then, CAQH does the rest. They’ll share it with all participating health plans that you authorize to receive it. This eliminates the need for every plan in which you participate to contact you for the same directory information.
CAQH will send you this notice, CAQH provider directory validation invitation e-mail, which has instructions on how to update your profile. CAQH will call you if you don’t reply, so respond promptly.
Provider Notice 4/28/16
ATTENTION: Due to a processing error discovered just before this week’s disbursements were issued, some hospital disbursements will be delayed until next week's check run. We apologize for any inconvenience this may cause.
Provider Notice 5/8/15
Group psychotherapy services
Effective 6/1/13 Aetna Better Health of Illinois will NO LONGER accept CPT Code 90853 as a covered benefit for group psychotherapy services to participants who reside in a long term care or nursing facility including Institutions for Mental Diseases (IMD). For more information see Illinois Department of Healthcare and Family Service (HFS) or contact Aetna Better Health of Illinois provider services at 1-866-212-2851 (ICP and Family Health Plan- FHP members) or 1‑866‑600-2139 (Premier Plan).
Prescription drug network change
Aetna Better Health wants to let you know of a change to our prescription drug network. Learn more about the prescription drug network change.
Notice for non-participating (non-contracted) providers
Effective August 15, 2012, Aetna Better Health is requiring non-participating providers to submit claims 180 days from the date of service. This timely filing guideline applies to dates of service beginning August 15, 2012 and later. Timely filing guidelines for participating providers remain unchanged. The timely filing guideline for participating providers is 120 days from the date of service.
Aetna Better Health is dedicated to providing great service to our providers and our members. That's why our HIPAA-compliant web portal is available 24 hours a day. The portal supports the functions and access to information related to:
- Prior authorization submission and status inquiry
- Claim status inquiry
- Eligibility status inquiry
- Provider search
- Member and provider education and outreach materials
For more information, contact your Provider Services representative at 1-866-212-2851 (ICP) or 1‑866‑600-2139 (Premier Plan) for more information.
Not registered for the secure web portal? Fill out the web portal registration form.
If you are already registered, log in here
Reclassification of hydrocodone combination products
As of October 6, 2014, hydrocodone combination products (HCP) will be reclassified from a schedule CIII to Schedule CII. No HCP issued on or after October 6, 2014 shall authorize refills. In addition, a hard copy paper written prescription is required and prescriptions for HCP cannot be phoned in or faxed to pharmacies. The DEA with agreement from the Food and Drug Administration (FDA) and the U.S. Department of Health and Human Services (HHS) is moving HCP to a higher restriction level for the following reasons:
i. these drugs are overprescribed
ii. addictive potential is high
iii. often diverted to black market due to abuse potential
iv. commonly causes users to seek addiction treatment
v. commonly seen in narcotic related overdose deaths and hospitalizations.
Although the DEA will allow refills to be dispensed for those prescriptions issued before October 6, 2014, many pharmacy systems do not have the capacity to treat the same drug as a schedule II and III at the same time. Therefore, although many patients may have refills, at most pharmacies, the claim will reject on or after October 6, 2014.
What does this mean for you? Expect that your patients on HCP will be contacting your office to obtain new prescriptions. If you have any questions, you can contact Aetna Better Health of Illinois Medicaid Plan at 1-866-212-2851 or Aetna Better Health Premier Plan at 1-866-600-2139.