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You can file claims with us electronically or online.  

Have questions?

You can check your provider manual (PDF). Or call Provider Relations at 1-833-711-0773 (TTY: 711).

Fee schedules and billing codes


You can find the billing codes you need for specific services in the Ohio Department of Medicaid fee schedules.


Fee schedules

Getting started

You must file claims within 365 days from the date of service. For inpatient claims, the date of service refers to the member’s discharge date.


Claims for members whose Medicaid eligibility is retroactively back-dated can be filed through the normal claims process.




You can submit claims electronically to Change Healthcare or Office Ally using payer ID: 45221. Just make sure your clearinghouse is compatible with either vendor before you submit.  


Note: We do not accept direct electronic data interchange (EDI) submissions from providers. While Aetna does not perform any 837 testing directly with our providers, you can complete testing directly with Change Healthcare.   




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


ConnectCenter portal


ConnectCenter user guide (PDF)


Once you’ve submitted claims, you can visit the Provider Portal to review claims payment information. 

You can resubmit a claim online through ConnectCenter or electronically though a clearinghouse. If you resubmit through the ConnectCenter portal, you’ll need to mark your resubmission with a "7” in the frequency code field. 

To learn more about claim appeals, just visit our appeals and complaints page.

A claim reconsideration is a request that we previously received and processed as a clean claim.


You can learn about the payment conditions in your provider manual (PDF). Claims payments are adjudicated in accordance with your Provider Agreement. The Centers for Medicare & Medicaid Services (CMS) prohibits plans from applying the mandated Medicaid member appeal process to providers.  


If you have questions about how your claim was paid, you can check on our Provider Portal or by contacting the Claims Inquiry Claims Research (CICR) Department at 1-833-711-0773 (TTY: 711). If there's an error, we’ll work with you to resolve the issue. In some situations, we may require you to resubmit the claim for reprocessing. 


Need to learn more about claims disputes? You can visit our grievances and appeals page.  


Grievances and appeals

Submit an invoice for reimbursement by Aetna for a CANS assessment when this service is not billable via a claim. The invoice needs to contain rendering provider info such as NPI to determine the proper level of reimbursement.


The EFT application for Electronic Funds Transfer needs to be submitted with any initial invoice.* CANS assessments must be submitted to the CANS IT System to be eligible for reimbursement. All invoices and questions should be sent to


*If an EFT application was previously submitted by the assessor (if they bill independently) or the assessor’s agency (if they bill through an agency), a new EFT application does not need to submitted again with the initial invoice. 

Electronic funds transfer (EFT) and electronic remittance advice (ERA)

Helpful resources


In addition to these resources, you can also check your provider manual (PDF).

We follow the same standards as Medicare’s Correct Coding Initiative (CCI) policy and perform CCI edits and audits on claims for the same provider, same recipient and same date of service. For more information, visit the Centers for Medicare & Medicaid Services (CMS) website.



We use ClaimsXten as our comprehensive code auditing solution that will help payers with proper reimbursement. Correct Coding Initiative guidelines will be followed in accordance with CMS and pertinent coding information received from other medical organizations or societies. 


Clear Claim Connection


Clear Claim Connection is a web‐based, stand‐alone code auditing reference tool designed to mirror our comprehensive code auditing solution through ClaimsXten. It enables us to share with our providers the claim auditing rules and clinical rationale inherent in ClaimsXten. You'll have access to Clear Claim Connection through our website and a secure login. You can use Clear Claim Connection coding combinations to review claim outcomes after a claim has been processed. You may also review Coding combinations before submitting a claim so that you can see claim auditing rules and clinical rationale before claim submission.



Correct coding


Correct coding means billing for a group of procedures with the appropriate comprehensive code. All services that are integral to a procedure are considered bundled into that procedure as components of the comprehensive code when those services:


  • Represent the standard of care for the overall procedure
  • Are necessary to accomplish the comprehensive procedure
  • Do not represent a separately identifiable procedure unrelated to the comprehensive procedure


Incorrect coding


Examples of incorrect coding include:


  • Unbundling: fragmenting one service into components and coding each as if it were a separate service
  • Billing separate codes for related services when one code includes all related services
  • Breaking out bilateral procedures when one code is appropriate
  • Down coding a service in order to use an additional code when one higher-level, more comprehensive code is appropriate

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