Claims

Aetna Better Health processes claims for covered services provided to members in accordance with applicable policies and procedures and in compliance with applicable federal and state laws, rules, and regulations. We do not pay claims submitted by a provider not participating in the KanCare Medicaid Program, or excluded from any program under federal law.

Providers have a variety of ways to submit claims:

For all claims

KMAP Portal

Electronically through KMAP front end billing:

www.kmap-state-ks.us/PROVIDER/SECURITY/logon.asp

For Medical Submissions (Claims that are not Dental, Vision or Non-Emergency Transportation Claims):

Claims (Professional-CMS 1500 and Institutional-UB04)

Electronic Portal (Professional-CMS 1500 and Institutional-UB04)

Aetna Better Health Secure Web Portal:

https://www.aetnabetterhealth.com/kansas/providers/portal

Our clearinghouses can be accessed through our Secure Web Portal. For specific clearinghouse information, please see Change Healthcare and Office Ally Inc. details below.

 

Paper Submission (Professional-CMS 1500 and Institutional-UB04)

Paper Claims Mail to:

Aetna Better Health of Kansas

P.O. Box 61838

Phoenix, AZ 85082

Professional-CMS 1500 only

Electronic Clearinghouse – Change Healthcare

Through Change Healthcare (www.changehealthcare.com):

  • Includes Claim Submissions for: Professional-CMS 1500 claims that are Medicaid primary
  • Excludes Claim Submissions for: Professional-CMS 1500 claims that are:
    • Medicaid tertiary
    • All Institutional-UB04 claims

 

Payer ID’s: 128KS (Claim Submission) and ABHKS (Real-Time)

Important: Dental providers must submit using SKYGEN’s payer ID. See below grid for the SKYGEN Change Healthcare payer ID information.

 

Note: Before submitting a claim through your clearinghouse, please verify that your clearinghouse is compatible with Change Healthcare

Professional-CMS 1500 only and Institutional-UB04

Electronic Clearinghouse –Office Ally

Through Office Ally Inc. (http://www.officeally.com/) except:

  • Claims where Medicaid is the third payer (tertiary claims)

Payer ID:  128KS

Note: Before submitting a claim through your clearinghouse, please verify that your clearinghouse is compatible with Office Ally Inc.

For Vendor submissions, please see below

Dental

Electronic Submissions:

Through

Payer ID: SCION

Paper Claims:

Aetna Better Health of Kansas - Claims

P.O. Box 359

Milwaukee, WI 53201

 

Excludes- All Professional CMS1500 and all Institutional UB04 claims

Important: Medical providers must submit using the payer ID #’s in the Professional-CMS 1500 only grid above.

Note: The clearinghouses cannot accept and convert paper ADA claims for electronic submission. The provider offices would need to submit the claim data to the clearinghouse from their practice software. Also, SKYGEN’s provider portal supports secondary and tertiary dental claims.

Vision

Electronic Submissions:

Through SKYGEN’s Provider Portal: https://ocularbenefitspwp.wonderboxsystem.com

or

Through:

Payer ID: L0140

 

Paper Claims:

Aetna Better Health of Kansas - Claims

P.O. Box 1607

Milwaukee WI 53201 

Excludes- All Institutional UB04 claims

For information about services that should be billed to SKYGEN vs. Aetna Better Health, please visit SKYGEN’s Secure Provider Web Portal  to view the Vision Benefit and Authorization Requirements document , or call SKYGEN directly at 1-855-918-2258.

 

Transportation

Electronic Submissions:

Through Access2Care:

www.Access2Care.net/transportation-providers

For paper submissions: 

Access2Care, LLC

6363 Fiddler’s Green Circle, Ste. #1400            

Greenwood Village, CO 80111

Note:

  • Aetna Better Health does not perform any 837 testing directly with its providers but performs such testing with Change Healthcare or Office Ally Inc. 

Aetna Better Health® of Kansas (Aetna Better Health) is prioritizing the loading of home and community based (HCBS) providers into our systems, including financial management services (FMS) providers.  Once providers are loaded, Aetna will align applicable authorizations for Aetna Better Health members to specific providers to pay claims.

The following outlines the timeline of this process:

  • HCBS providers, whether participating or non-participating providers with Aetna Better Health, will be loaded by January 18, 2019.
  • Existing authorizations will be aligned to the loaded HCBS providers by January 21, 2019.
  • Once authorizations are aligned to the HCBS provider records, providers will be able to see the authorizations in First Data AuthentiCare after January 22, 2019.

If claims are received by Aetna Better Health while the provider records and authorizations are being loaded, we will manually review the Amerigroup authorization file to align authorizations with claims and process payment.

Aetna Better Health appreciates your continued cooperation as we work through this process.  If you have any questions, please contact Provider Experience at 1-855-221-5656.

  • Aetna Better Health of Kansas conducts two payment cycles a week.  The pay cycles generate payments on Tuesdays and Fridays. 
  • Payments (checks and remits) from the Tuesday paid date are mailed Wednesday.  EFT’s are available beginning Wednesday. 
  • Payments (checks and remits) from the Friday paid date are mailed Monday.  EFT’s are available beginning Monday. 

Electronic fund transfer offers electronic payments deposited directly into providers’ bank accounts.

The benefits of an EFT Setting up EFT payments will:

  • Improve payment consistency
  • Ensure fast, accurate and secure transactions
  • Send payments directly into your bank account

EFT forms are available through the provider portal and through the Forms section of this website.

Electronic remittance advice is an electronic file that contains claim payment and remittance information sent to your office. This is sometimes referred to by its HIPAA transaction number, 835.

The benefits of an ERA

  • Reduces manual posting of claims payment information, which saves you time and money, allowing you to more efficiently manage your resources
  • Eliminates the need for paper explanation of benefits (EOBs)

 ERA forms are available through the provider portal and through the Forms section of this website.

Note:

  • Aetna Better Health does not perform any 837 testing directly with its providers but performs such testing with Change Healthcare or Office Ally Inc.