Participating Providers: To determine if prior authorization (PA) is required please click here.
Aetna Better Health℠ Premier Plan requires prior authorization for select services. However, prior authorization is not required for emergency services.
To request a prior authorization, be sure to:
- Always verify member eligibility prior to providing services
- Complete the appropriate authorization form (medical or prescription)
- Attach supporting documentation
If covered services and those requiring prior authorization change, we will notify you at least 60 days in advance via the provider newsletter, e-mail, website, mail, telephone or office visit.
Remember, we don’t reimburse for unauthorized services. Also, prior authorization is not a guarantee of payment.
To request an authorization, find out what services require authorization, or check on the status of a request, just visit our secure provider website. See your provider manual for more information about prior authorization.
For assistance in registering for or accessing the secure provider website, please contact your provider relations representative at 1-855-676-5772 (TTY 711). You can also fax your authorization request to 1-844-241-2495.
When you request prior authorization for a member, we’ll review it and get back to you according to the following timeframes:
- Routine – 14 calendar days upon receipt of request.
- Urgent – 3 business days upon receipt of request. An urgent request is appropriate for a non-life-threatening condition, which, if not treated promptly, will result in a worsened or more complicated patient condition. We encourage you to call the Prior Authorization department at 1-855-676-5772 for all urgent requests.
Peer to Peer Consultations
Peer to peers are scheduled by calling 1-855-711-3801 ext. 1. within the timeframe outlined in the denial notification. Peer-to-peer consultations occur between the treating practitioner and an Aetna Better Health medical director. Peer-to-peer consultation occurs timely in accordance with the member’s clinical need. Someone other than the treating practitioner can call to schedule the peer-to-peer consultation at the request of the treating practitioner. Peer to peers are not performed in the case of a retrospective review, in these instances the appeals process is to be followed.
We work with certain subcontractors to coordinate services such as transportation, vision or dental services. If you have a member who needs one or more of these services, please contact Member Services at 1-855-676-5772 for more information.