Claims

Aetna Better Health of Ohio encourages providers to electronically submit claims, through Emdeon. 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 via Emdeon Office. Emdeon Office is a contracted vendor used by Aetna Better Health of Ohio for electronic claim submission, processing and support. To read the Webconnect manual click here.

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 64205
Phoenix, AZ 85082

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 64205
Phoenix, AZ 85082

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.