Independent Review Forms
A Request for Reconsideration, the first step in the claim dispute process, must be filed within 180 calendar days of the date of the initial Explanation of Benefits (EOB). The provider will receive an EOB noting payment amount, denial or adjustment.
A Request for Reconsideration may be filed in writing by including a Provider Claim Dispute Form. It is recommended that the Provider Claim Dispute Form and supporting documentation be forwarded utilizing a trackable mail service to ensure receipt. Claim status can be tracked on our secure provider portal while awaiting the new EOB.
An Appeal, which is filed when a provider is not satisfied with the result of a Reconsideration, must also be filed in writing. This must be filed within 180 calendar days of the Reconsideration response (date of EOB). The provider will receive a final determination letter with the appeal decision, rationale, and date of decision.
We will resolve provider Appeals within 30 business days, or we will notify the provider of the delay reason and the expectation for resolution.
If the Appeal decision is not in the favor of the provider, the provider may not bill the member for services or payment denied by the Plan.
Independent Reconsideration Review Request:
The Louisiana Department of Health (LDH) created the Independent Reconsideration Review Form for Louisiana Managed Care Organizations (MCOs) as a final reconsideration process before submitting a dispute to a third party for Independent Review.
A provider has 180 days from one of the following dates to request reconsideration from Aetna Better Health of Louisiana:
- The date on which Aetna Better Health of Louisiana transmits the remittance advice or other notice electronically, OR
- Sixty (60) days from the date the claim was submitted to Aetna Better Health of Louisiana if the provider receives no notice from Aetna Better Health of Louisiana, either partially or totally, denying the claim, OR
- The date on which Aetna Better Health of Louisiana recoups monies remitted for a previous claim payment.
Aetna Better Health of Louisiana will acknowledge receipt of the Independent Reconsideration Review in writing within 5 calendar days and will render a decision within 45 days of receipt.
If Aetna Better Health of Louisiana reverses the reconsideration, the payment of disputed claims shall be made no later than 20 days from the date of Aetna Better Health of Louisiana’s decision. If Aetna Better Health of Louisiana upholds the adverse determination or does not respond to the reconsideration request within the timeframes allowed, the provider has 60 days to request an Independent Review with a third-party panel.
To file an Independent Reconsideration Review, please complete the Independent Reconsideration Review Form (PDF), include all supporting documentation, and submit to Aetna Better Health of Louisiana via email or mail to:
Email: Independentreviewrequest@AETNA.com (Preferred method)
Mail: Aetna Better Health of Louisiana
ATTN: Grievance and Appeals
2400 Veterans Memorial Blvd, Suite 200
Kenner, LA 70062