Claims

Aetna Better Health of Ohio encourages providers to electronically submit claims, through WebConnect. Please use the following Submitter ID and Provider ID numbers when submitting claims to the health plan: Submitter ID# 50023 and Provider ID# 0082400 for both CMS 1500 and UB 04 forms. (Federally Qualified Health Centers and Rural Health Clinics must use the Provider ID # when billing Ohio Department of Medicaid.)

WebConnect is our free provider claims submission portal and has replaced Emdeon Office as of April 2021.  To read the WebConnect manual click here.

In order to ensure that you have as much time as possible to transition to ConnectCenter, we highly recommend that you start using it immediately. Change Healthcare has produced and made available the Getting Started with the Sign-Up process guide (PDF) to assist in general navigation and registration with ConnectCenter powered by Change Healthcare office.

Please review the guides below for verifying member eligibility and claim submissions.

 

Contact your Provider Services representative for more information on electronic billing.
Or you can mail hard copy claims or resubmissions to:

Aetna Better Health of Ohio (MyCare Ohio Program)
PO Box 982966
El Paso, TX 79998-2966

Resubmitted claims should be clearly marked “Resubmission” on the envelope.

For out-of-network providers seeking payment of claims for emergency, post-stabilization and other services authorized by us, please refer to the policies and procedures in the provider manual.

Definitions & Helpful Links:

Claim Resubmission (Corrected Claim) – a claim that is resubmitted to ABHO via the same process of a new day claim (via provider’s claims tool, Aetna’s claims portal, or mailed) but the claim itself has been corrected in some way and the claim is designated as ‘Corrected’ via Bill Type code. Paper claims should also have the word ‘RESUBMISSION’ written across the top of the claim.

Please note, claim resubmissions are mailed to the following address:

Aetna Better Health of Ohio
PO Box 982966
El Paso, TX 79998-2966

Claim Reconsiderations for PAR providers (Dispute) – a claim for a PAR provider in which the provider is not correcting the claim in anyway, but disagrees with the original claim outcome and wishes to challenge the payment or denial of a claim. This requires the provider to fill out the PAR Provider Dispute Form:

Alternatively, a PAR provider can also submit a Reconsideration via the secure web portal for better convenience. This requires the provider to request access to the portal. Once the provider has access, instructions for reconsideration thru the portal can be found here.

Claim Reconsiderations for non-PAR providers (Appeal) - a claim for a non-contracted provider in which the provider is not correcting the claim in anyway, but disagrees with the original claim outcome and wishes to challenge the payment or denial of a claim. This requires the provider to fill out the non-PAR Provider Appeal Form:

You may submit an appeal for a claim denied based on error or absence of fact, except for timely filing.  Federal regulations 42 CFR 42 § 422.504(g) requires us to protect Aetna Better Health members from financial liability, therefore, appeals must include a signed Waiver of Liability (WOL) form.

Please note, these are mailed to the New Albany, Ohio address listed at the top of the form.

Aetna Better Health of Ohio has partnered with Change Healthcare to introduce the EFT/ERA Registration Services (EERS), a better and more streamlined way for our providers to access payment services.

EERS offers providers a standardized method of electronic payment and remittance while also expediting the payee enrollment and verification process. Providers can use the Change Healthcare tool to manage ETF and ERA enrollments with multiple payers on a single platform.

How does it work?
EERS gives payees multiple ways to set up EFT and ERA in order to receive transactions from multiple payers. If a provider’s tax identification number (TIN) is active in multiple states, a single registration will auto-enroll the payee for multiple payers. Registration can also be completed using a national provider identifier (NPI) for payment across multiple accounts.
Providers who currently use Change Healthcare as a clearinghouse will still need to complete EERS enrollment, but providers who currently have an application pending with Change Healthcare will not need to resubmit. Once enrolled, payees will have access to the Change Healthcare user guide to aid in navigation of the new system.

How and when do I enroll?
All Aetna Better Health plans will migrate payee enrollment and verification to EERS. To enroll in EERS, please visit https://payerenrollservices.com/.