Skip to main content

Claims

You can file claims with us electronically or through the mail. We work to streamline the way we process claims. And improve payment turnaround time, so you can save time and effort. For claims processing updates, visit our notices and newsletters page.

 

Have questions?

You can download the provider manual (PDF).

 

Or contact us to learn more.

How do I file a claim?

You can file a claim:

You can submit claims or resubmissions online through ConnectCenter using payer ID 38692. These come directly to the Medicaid/CHIP claims system. 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.”

 

You must have a Medicaid provider agreement with HHSC or its agent to participate in the Medicaid Program.

 

ConnectCenter portal

ConnectCenter user guide (PDF)

 

Availity
Availity.com  
1-800-282-4548

 

Change Healthcare 
ChangeHealthcare.com  
1-866-371-9066

You can also mail hard copy claims or resubmissions to:

 

Aetna Better Health®
PO Box 982964
El Paso, TX 79998-2964

 

Mark resubmitted claims clearly with “resubmission” to avoid denial as a duplicate.

 

CMS-1500 sample (PDF)

 

UB-04 sample (PDF)

How can I submit a claim reconsideration?

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

  • A claim form for each reconsideration
  • A copy of the remit/Explanation of Benefits (EOB) page for each resubmitted claim, with a brief note about each claim you’re resubmitting
  • Any information that the health plan previously requested

 

Be aware that we:

 

  • Process and decide claims within 30 days of receipt. This includes:

    • Completing the appeal and reprocessing.
    • Processing clean payments for professional and institutional claim submissions.
  • Process and decide claim reconsiderations within 120 days of the resolution date on the original (clean) claim’s EOB.
  • Identify a Coordination of Benefit (COB) resubmission as a claim previously denied for other insurance info, or originally paid as primary without coordination of benefits.
  • Process and decide COB claim reconsiderations within 95 days from the disposition date on the primary carrier’s EOB or response letter.

We can’t accept COB reconsiderations via electronic transmission.

 

You can file a claim reconsideration by mail:

 

Please mail your reconsideration form (PDF) and all supporting documentation to the following address: 

Aetna Better Health of Texas
PO Box 982964
El Paso, TX 79998-2964

 

Learn more about claim appeals

 

More info

Electronic Funds Transfer (EFT) and Electronic Remittance Advice ( ERA) Registration Services (EERS)

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

Electronic funds transfer (EFT)

EFT makes it possible for us to deposit electronic payments directly into your bank account. Some of the benefits of setting up an EFT include:

 

  • Improved payment consistency
  • Fast, accurate and secure transactions

 

Electronic remittance advice (ERA)

ERA is an electronic file that contains claim payment and remittance info sent to your office. The benefits of an ERA include:

 

  • Reduced manual posting of claim payment info, which saves you time and money, while improving efficiency
  • No need for paper Explanation of Benefits (EOB) statements

 

All Aetna Better Health plans will migrate payee enrollment and verification to EERS; your individual health plan will reach out with state-specific enrollment deadlines. To enroll in EERS, please visit

https://payerenrollservices.com/.

Providers currently enrolled with ABHTX EFT/ERA will not be impacted by this.

 

For questions or concerns, please visit the Change Healthcare FAQ page.

Change Healthcare FAQ page.- https://payerenrollservices.com/faq

 

Contact Change Healthcare

1-800-956-5190

Monday-Thursday 8AM-5PM CT

Helpful resources 

 

Check out these resources to learn more about claims submissions and International Classification of Diseases, Tenth Revision (ICD 10).

 

Centers for Medicare and Medicaid Services

 

American Academy of Professional Coders

 

American Health Information Management Association documentation tips (PDF)

Also of interest: