EDI Documentation

At Aetna Better Health of Kentucky, we value the providers who take care of our Medicaid members. Our improved website offers you new tools and more effective electronic solutions to assist with patient care.

EFT online enrollment is available on our provider portal.
Get your payment faster with EFT. Enrollment for EFT payments is available to all providers. Please go to our provider portal to complete the electronic EFT enrollment form online or download a paper form. A paper EFT enrollment form may also be requested through e-mail. The EFT Forms comply with the CAQH (Council for Affordable Quality Healthcare) CORE (Committee on Operating Rules for Information Exchange) rules.

Please note: there may be other EFT forms on this website that are used for members and brokers. Those forms can only be used for member and broker EFT enrollments and cannot be used for medical claims payments to providers. Only the form found on the provider portal can be used for provider medical payments.

Aetna Better Health encourages all participating providers to submit electronic claims whenever possible. Aetna Better Health can receive initial and corrected claim submissions for both professional and facility claims. EDI claims are NOT considered received until claims have passed clearinghouse edits and are accepted into the Aetna Better Health system.

Providers must review all reject reports from the clearinghouse to verify acceptance and payments are always subject to member eligibility on the date of service.

Aetna Better Health has partnered with Emdeon to provide electronic services to our providers. Aetna Better Health has implemented electronic claim filing in order to meet the Health Insurance Portability and Accountability Act (HIPAA) compliance standards. Additional electronic claim submission information is available. Please verify with your practice management vendor regarding file formatting and information on how to submit claims.

Clearinghouse

Payor ID #

Claim Type

Contact Number

Emdeon

128KY

UB and CMS

1-877-GO-WEBMD

 

Electronic Submission of Corrected Claims

Corrected or replacement claims may be submitted electronically. Use the Claim Frequency Type Code (CLM05-3) in the 837 5010 EDI format. A value in this field equal to “7” indicates a replacement claim. Additionally, Aetna Better Health accepts the following:

Claim Type Frequency Code (code set 235)

Code

Meaning

7

Replacement of Prior Claim

8

Void/Cancel of a Prior Claim

Any other code (including 1) submitted in the claim type frequency code will not be flagged in our system as a resubmission and will be adjudicated as original submission. The above field code values are for 5010 professional claims. Institutional claims submission use the same code values submitted in the last position of the type of bill field.

 

Corrected claims must include all original claim lines, including those previously paid correctly. Resubmitted claims without all original claim lines may result in the recoupment of correct payments.

Send the claim electronically. Include a valid attachment code in the EDI claim supplemental information paperwork segment and retain the documentation at the office until contacted by Claims Member Services. Provider must fax requested documentation within forty-eighty (48) hours of request or the claim will be denied