News & Notices

Stay up to date with all the latest notifications from Aetna Better Health of Ohio, and more.

Let us know if you would like us to send Provider Notifications directly to your email.

 

Provider Notice 11/13/2019 – PDGM Changes

 

Dear Home Health Provider,

Aetna Better Health of Ohio wanted to provide your organization with an FAQ related to upcoming Medicare changes related to the new Patient-Driven Groupings Model (PDGM). Please share this with staff and billers for your organization. We hope this will assist you when billing Aetna for Home Health claims. 

Frequently Asked Questions

  • Does Aetna have plans to adopt the Patient Driven Groupings Model (PDGM) per Medicare Part A billing requirements?
  • Yes. Aetna will implement the PDGM payment model for Skilled Home Health Medicare Part A billing.
  • Does Aetna plan to change the existing claim billing requirements to accommodate the new PDGM components such as the submission of a PDGM HIPPS Code and/or other information on Medicare claims?
  • Providers should bill using Medicare guidelines. Aetna will use a pricing tool (Burgess) for calculating claim payments that is consistent with Medicare Fee For Service. The payment changes will be reflected in claims with Dates of Service (DOS) on or after the effective date of PDGM being implemented in our system. Aetna will follow all contractual arrangements and negotiated arrangements regarding reimbursement. Most provider contracts are 100% Medicare allowable.
  • When does Aetna plan to implement PDGM requirements and/or changes?
  • Our changes will align with Medicare effective date which would be 1/1/20 Dates of Service (DOS) forward.

Additional information can be found related to the PDGM Medicare changes at the following sites:

Should you have any questions related to this communication, please contact our Provider Experience department at 1-855-364-0974.

Sincerely,

Aetna Better Health of Ohio

Provider Experience

Provider Notice PN191113-001

Provider Notice 10/30/2019 - Secondary Medicaid Payment Responsibility in Coordination of Benefits (COB) Situations

 

Dear Provider,

 

Aetna Better Health is committed to ensuring that the claims you submit are processed in a timely and accurate manner. Aetna Better Health serves as a Medicaid managed-care organization (MCO) on behalf of the State of Ohio and arranges for the provision of covered services to its members. When more than one program or payer has payment responsibility for a particular service rendered to a member—for example, when a service is covered under both Medicare and Medicaid—Aetna Better Health follows applicable coordination-of-benefits (COB) principles to determine which program/payer has primary payment responsibility (PPR) for that service. This COB analysis includes a determination of the amount payable by the program/payer having PPR, along with the amounts, if any, payable by programs/payers that have secondary or lower payment responsibility. If a service is covered under both Medicaid and another program/payer, Medicaid never has PPR.

 

Under established COB principles, if the amount of the payment made by the program/payer having PPR (e.g., Medicare) exceeds the amount that the secondary program/payer (e.g., Medicaid) would have paid if it had PPR, then the secondary program/payer has no payment responsibility.

 

Aetna Better Health has identified an error in the COB method with outpatient claims by which it calculated the Medicaid amount that is secondarily payable when Medicare has PPR for a particular service. Specifically, Aetna Better Health erroneously made certain secondary payments to providers when, under the COB principle described above, the Medicaid amount that was secondarily payable should have been zero.

 

Please be advised, going forward Aetna Better Health will apply the above-described COB principle strictly and consistently. As a result, the aggregate amount that providers receive from Aetna Better Health for certain services may decrease now that the secondarily payable Medicaid amounts on those services will be zeroed out appropriately. Aetna Better Health will be reprocessing outpatient claims with a date of service on or after 08/02/2018 and apply this correct COB principle.

 

Thank you for your participation. We look forward to continuing a successful working relationship. If you have further questions about the information in this notice, please contact your Network Account Manager or Provider Services at 1-855-364-0974.

 

Sincerely.

 

Aetna Better Health of Ohio

Provider Services

Provider Notice PN191030-001

Provider Notice 09/03/2019- S5121 and S5135 modifier edit

 

Dear Waiver Providers,

 

This is a notification of a recent Ohio Department of Medicaid billing change that is affecting certain waiver providers.   Beginning 7/01/2019, providers that are billing service codes S5121 (OH Home Maintenance and Chore) or S5135 (OH Community Integration) should not use a modifier. If a provider submits a claim for either of these codes with a modifier the claim will deny and the provider will need to rebill with a corrected claim.

 

If you have any questions for Aetna Better Health of Ohio regarding this update, please contact Provider Services at 1-855-364-0974.

 

Sincerely,

Aetna Better Health of Ohio

Provider Services

Provider Notice PN190903-001

Provider Notice 08/28/2019- Patient-Driven Payment Model (PDPM)

 

Dear Skilled Nursing Facility,

 

Aetna Better Health of Ohio wanted to provide your organization with an FAQ related to upcoming Medicare changes related to the new Patient-Driven Payment Model (PDPM). Please share this with staff and billers for your organization.  We hope this will assist you when billing Aetna for SNF claims.

 

Frequently Asked Questions:

  • Does Aetna have plans to adopt Medicare’s PDPM payment model?
  • Yes. Aetna will implement the PDPM payment model for SNF claims.
  • Does Aetna plan to change the existing claim billing requirements to accommodate the new PDPM?
  • Providers should bill using Medicare guidelines. Aetna will use a pricing tool (Burgess) for calculating claim payments that is consistent with Medicare Fee For Service (FFS). The payment changes will be reflected in claims with Dates of Service (DOS) on or after the effective date of PDPM being implemented in our system.  Aetna will follow all contractual arrangements and negotiated arrangements regarding reimbursement. Most provider contracts are 100% Medicare allowable.
  • When does Aetna plan to implement PDPM requirements and/or changes?
  • Our changes will align with the Medicare effective date which is any claim with a Date of Service (DOS) 10/1/19 forward.

 

Additional information can be found related to the PDPM Medicare changes at the following sites:

 

Should you have any questions related to this communication, please contact our Provider Experience department at 1-855-364-0974.

 

Sincerely,

Aetna Better Health of Ohio

Provider Experience Team

 

Provider Notice PN190828-001

Provider Notice 8/23/2019 – SNF Rates

 

Dear Skilled Nursing Facility providers,

 

At the beginning of the fiscal year, Ohio Department of Medicaid (ODM) provided all managed care plans with the skilled nursing facility (SNF) rates beginning on July 1, 2019. Due to the delay in the passage of the state budget, ODM requested that no SNF rates payments be made until the state budget was passed and the appropriate rate of payment could be established for the delay period.  Since the budget has now passed, Aetna will proceed with paying SNF for services provided beginning July 1, 2019 with the June 30, 2019 rates for the period of July 1, 2019 through and including July 17, 2019.  ODM has supplied updates rates for the period of July 18 forward. 

 

Claims with DOS 7/1/2019 – 7/17/2019 (will pay June 30th rate) and DOS 7/18/2019 – 7/31/2019 (will pay new rate).

 

Provider Actions

Due to the rate change in the middle of the month providers will need to split dates of services on separate claim lines. If you have already submitted a claim with all dates of service on one line you will need to submit a corrected claim.

Example of billing for DOS 7/01/2019 – 7/31/2019

Claim Line 1 DOS 7/01/2019 - 7/17/2019

Claim Line 2 DOS 7/18/2019 - 7/31/2019

 

If you have any questions for Aetna Better Health of Ohio regarding this update, please contact Provider Services at 1-855-364-0974.

 

Sincerely, 

 

Aetna Better Health of Ohio

Provider Services

Provider Notice PN190823-001

Provider Notice 7/31/19- 340B Drug Program

 

Dear Provider,

 

Beginning January 1, 2018, Medicare pays an adjusted amount of the average sales price (ASP) minus 22.5% for certain separately payable drugs or biologicals that are acquired through the 340B Drug Program and are furnished to a Medicare beneficiary by a hospital paid under the OPPS(Outpatient Prospective Payment System)  that is not excepted from the payment adjustment policy. For purposes of this policy, “acquired through the 340B Drug Program” means that the drug was purchased at or below the 340B ceiling price from the manufacturer and includes 340B drugs purchased through the Prime Vendor Program. Medicare will continue to pay for separately payable drugs that were not acquired through the 340B Drug Program and furnished by a hospital paid under the OPPS at ASP plus 6%.

 

Aetna Better Health of Ohio has determined that our configuration for Medicare Part B 340B drug reimbursement has not been properly reducing payment by 22.5% for outpatient drugs. If you are a 340B covered entity and part of the Prime Vendor Program, it is expected that your claims for 340B drugs purchased through the program should include either the JG or TB modifier. When the JG modifier is appended, the 22.5% reduction will occur. If the TB modifier is present, no reduction in payment will occur.

 

Aetna Better Health of ­­Ohio is taking steps to configure its system to align with Medicare’s requirement. We will be recouping and correcting overpaid claims dating back one year from DOS July 1, 2018, to present. As we work on the configuration, which includes a 3-step validation (provider is 340B covered, the drug is a 340B drug, and the JG modifier is present) before reducing the payment, we are exploring the timeline for the recoupment with our claims department. We expect the recoupment to occur in the next 30 to 45 days.

 

For more information regarding the 340B Drug Program, please visit the following sites or contact Provider Services team at 1-855-364-0974 or send an email to OH_ProviderServices@aetna.com.

 

For more information, please visit:

If you are not a 340B covered entity participating in the Prime Vendor Program with HRSA, this memo does not apply to you at this time.

 

Sincerely,

Aetna Better Health of Ohio

Provider Notice PN190731-001

Provider Notice 07/17/2019 - New Updates on Clinical, Payment and Coding Policies 

 

Dear Provider,

 

A review of processes has been completed and changes will be updated to the current clinical, payment and coding policy positions. The attached documentation will provide additional information.   

Please feel free to reach out to Provider Services at 1-855-364-0974, if there are additional questions.

 

Sincerely,

Aetna Better Health of Ohio

 

Provider Notification PN190717-001

Provider Notice 06/13/2019 - Provider Check Delays

 

Dear Provider,

Due to a system error, we are notifying you that Aetna Better Health of Ohio’s check run that is normally scheduled to happen each Saturday will not occur this week as planned.  Our Saturday June 15th check run will be delayed and will now occur on Tuesday June 18th. We do not anticipate any future check run delays related to this issue.

We apologize for the delay and any inconvenience this issue may have caused.  However, the delay is being done in an effort to ensure provider’s checks are received for the correct amounts.  If you have any questions, please do not hesitate to reach out to our Provider Services department by calling 1-855-364-0974. 

We appreciate your understanding, and for your service to our members. 

 

Sincerely,

Aetna Better Health® of Ohio

Provider Experience

 

Provider Notification PN190613-001

Provider Notice 6/11/2019- Electronic Visit Verification (EVV) training

 

Phase 2 of EVV is fast approaching and important EVV training information can be accessed here.  

 

Provider Notification PN190611-001

Provider Notice 5/31/2019- Incontinence Supply Codes

 

May 31st, 2019

 

Dear Provider, 

 

Effective September 1, 2019, Aetna Better Health of Ohio will not require prior authorization for the following CPT/HCPCS code before services are rendered. 

Please note the allowable units for each service below.

 

CODE

DECRIPTION

ALLOWABLE UNITS

T4545

Incontinence product, disposable, penile wrap, each

200 / Month

 

 

Should you have any questions related to this change in PA, please don't hesitate to contact our Provider Experience team at  1-855-364-0974. 

Thank you for your continued dedication to our members!

 

Sincerely,

Provider Experience

Aetna Better Health of Ohio

 

Provider Notification PN190531-001

Provider Notice 05/07/2019 Hospice Providers

 

Dear Hospice & Skilled Nursing Facility providers,

 

Recently, the Ohio Department of Medicaid (ODM) provided clarification to Managed Care Organizations related to Hospice providers billing for Skilled Nursing Facility (SNF) Room & Board.

Per the Center for Medicare and Medicaid Services (CMS) regulations, when an individual resides in a SNF and is receiving hospice services, the hospice provider must bill the managed care plan for room and board.

CMS has indicated that room and board payment needs to go to the hospice provider (and not the skilled nursing facility) because they are considered the provider of record per SSA 1905(o)(3)(C). Furthermore, 1902(a)(32) and 42 CFR 447.10 prohibits provider payment reassignment.

 

Per this guidance and regulation, beginning with dates of service July 1, 2019 or after, Aetna Better Health of Ohio (a MyCare plan) will only accept billing from Hospice providers for room and board services when an individual is receiving hospice services and resides in a skilled nursing facility.

 

Hospice provider must:

 

Note: Hospice Providers DO NOT need to obtain an authorization

 

SNF provider must:

  • Continue to bill for R&B for members in Hospice for dates of service thru 6/30/19 on UB04
  • No longer bill rev code 0658 for DOS on or after 7/1/19

 

Please Note: Aetna Better Health of Ohio will NOT be contracting with Hospice providers since Hospice services are carved out of MyCare, but will pay Hospice providers as non-PAR for claims for SNF Room & Board services.  Please refer to our provider manual for information about timely filing, claim submission, and resources available to you as a non-PAR provider.

 

Beginning with dates of services July 1, 2019 or after, Aetna will deny any skilled nursing facility claims for room and board that are billed directly by the skilled nursing facilities for individuals receiving hospice. SNFs should work with their partner Hospice providers accordingly for reimbursement if applicable.

 

Ventilator Dependent Members:

In the rare instance that a member who is ventilator dependent or ventilator weaning, the SNF is reimbursed at the ventilator enhanced rate. Hospice providers shall work with the SNF to identify the SNF’s ventilator status with ODM for submitting ventilator room and board claims. Hospice providers should submit the proper U1, U2, U3, or U4 modifier for their claims per the chart below:

Description of service Specialty code RCC DX Code Modifier Rate
Vent dependent- full rate for meeting VAP threshold 862 419 Z99.11 U1 $819.49
Vent dependent rate 5% reduction for not meeting VAP threshold 864 419 Z99.11 U2 $778.52
Vent  weaning- full rate for meeting VAP threshold 867 410 Z99.11 U3 $983.39
Vent weaning -5% reduction for not meeting VAP threshold 868 410 Z99.11 U4 $934.22

 

Members with a Patient Liability:

When applicable, Aetna Better Health is required to deduct Patient liability for SNF member’s Room and Board claims.  Effective 7/1/19, Aetna Better Health will begin reimbursing the Hospice provider for room and board,  as well as deduct the full  member’s patient liability from the Hospice provider’s claim  according to  the member’s eligibility file from ODM where patient liability is reported. If the Patient Liability exceeds the total on the claim, the remaining balance of patient liability will be deducted off any hospice claims submitted for that member during the same month based upon the date of service.  It is still the SNF’s responsibility to collect the member’s patient liability, so Hospice providers will need to coordinate with SNFs related to Patient Liability accordingly.

 

If you have any questions for Aetna Better Health of Ohio regarding this update, please contact Provider Services at 1-855-364-0974.

 

Sincerely, 

 

Aetna Better Health of Ohio

Provider Services

Provider Notification PN190507-001

 

Provider Notice 04/11/2019 Ambulance Providers

 

Aetna Better Health of Ohio identified an issue that was causing certain claims deny inappropriately. Click here for additional information regarding the dates and codes affected. 

 

                                                                                                                                                                                                   Provider Notification PN190411-001

Provider Notice 03/26/2019 Behavioral Health claims

 

Dear Behavioral Health Provider,

 

Some Behavioral Health claims containing codes which are payable only under the Medicaid line of business did not bypass Medicare properly in our system, resulting in incorrect payments, primarily a short payment. The codes included in this error were:

 

90785, 90791,90832, 90834, 90837, 90839, 90840, 90846, 90847, 90853, 96101, 99354, 99355, G0396, G0397, H0006, H0036, H2017, H2019.

 

We identified claims that were affected starting on 7/1/18 through 3/19/19. Aetna is currently in process of having all effected claims reprocessed and expects the project to complete in mid-April.  If you do not see a correction to your claim and feel the payment was underpaid, please reach out to either your Provider Relations Liaison or our Provider Services team at OH_ProviderServices@aetna.com.

 

We apologize for any inconvenience this error may have caused and thank you for your continued service to our members.

 

Sincerely,

Provider Services

Aetna Better Health® of Ohio

 

Provider Notification PN190326-001

 

Provider Notice 03/26/2019 Behavioral Health claims with specialty providers

 

Dear Behavioral Health Provider,

 

Recently, Aetna Better Health of Ohio identified an issue that effected payment on 4 separate Behavioral Health codes:

 

H0006, H0036, H2017, H2019

 

Claims containing these codes did not price correctly based on the provider specialty being billed on the claim, resulting in a zero-dollar payment. This issue effected claims starting with Dates of Service starting 1/1/19, and our system was corrected for any claims received after 3/19/19.

 

All effected claims are currently being reprocessed to pay the correct rate and will be completed by mid-April. If you do not see a correction to your claim and feel the payment was underpaid, please reach out to either your Provider Relations Liaison or our Provider Services team at OH_ProviderServices@aetna.com .

 

We apologize for any inconvenience this error may have caused and thank you for your continued service to our members.

 

Sincerely,

Provider Services

Aetna Better Health® of Ohio

 

Provider Notification PN190326-002

Provider Notice 03/26/2019 Denials on claims for billing codes requiring no authorization

 

Dear Provider,

 

Aetna Better Health of Ohio previously communicated prior to the beginning of the year a list of codes that would no longer require authorization starting 1/1/19.

 

These changes were put in place for the codes listed on that communication, however, on 3/12/19, a system issue switched these codes back to ‘authorization required’ status causing denials in error. We identified this issue quickly and have put mechanisms in place to prevent these claims from denying for no authorization starting 3/20/19.

 

All effected claims are currently being reprocessed to pay the correct rate and will be completed by mid-April. If you do not see a correction to your claim and feel the payment was underpaid, please reach out to either your Provider Relations Liaison or our Provider Services team at OH_ProviderServices@aetna.com .

 

We apologize for any inconvenience this error may have caused and thank you for your continued service to our members.

 

Sincerely,

Provider Services

Aetna Better Health® of Ohio

 

Provider Notification PN190326-003

Provider Notice 03/13/2019 Claims for Behavioral Health, Durable Medical Equipment and Home Health Agency providers

 

Dear Provider,

On February 27th, Aetna identified an issue that effected claims for Behavioral Health, Durable Medical Equipment and Home Health Agency providers.  Claims affected from the issue span adjudication dates of 2/6/19 thru 3/1/19.

 

Only claims for Opt-Out members were affected. Certain codes which are Medicaid only covered services were denying incorrectly for no EOB (Remit Edit 377). Aetna Better Health of Ohio has already reprocessed and paid majority of claims affected, and anticipate all claims affected to be reprocessed no later than 4/15.

 

If you have any claims that meet the criteria above that have not been reprocessed and paid after 4/15, please reach out to Provider Services at 1-855-364-0974 or contact your Provider Relations Liaison for further assistance.

 

We apologize for the issue, and are working to resolve it as quickly as possible.

 

Thank you for your continued service to our members.

 

Sincerely,

Provider Services

Aetna Better Health® of Ohio

 

Provider Notification PN190313-001

 

Provider Notice 01/28/2019 Assisted Living billing codes for Skilled Nursing Facilities (SNF)

 

Ohio Department of Medicaid (ODM) confirmed for Aetna Better Health of Ohio that Assisted Living claims must be billed using a unique Medicaid ID that is authorized for Assisted Living specifically. The attached information will provide additional details for the correct billing codes. 

 

 

                                                                                                                                                                                                   Provider Notification PN190128-001

Provider Notice 01/17/2019 Electronic Visit Verification Communication

 

Aetna Better Health of Ohio would like to share provider-related information for the Electronic Visit Verification program. Click here to see the latest information from the Ohio Department of Medicaid. 

 

                                                                                                                                                                                                                                                     Provider Notification PN190117-001

Provider Notice 11/27/2018 - Waiver Service Authorization Attestation

Effective January 1, 2019, Aetna Better Health of Ohio will be requiring attestations from certain waiver providers for authorized services. Click here to see a list of provider types effected.

 

Provider Notification PN181127-001

Provider Notice 12/21/2018 Utilization Management FAQ’s for Providers

 

Aetna Better Health of Ohio has made a change to the pre-denial communication. Click here to see a list of FAQ’s for Utilization Management.

 

                                                                                                                                                           Provider Notification PN181221-001

Provider Notice 11/20/2018 - Pre-Denial Process for Urgent Authorization Requests

 

Aetna Better Health of Ohio has made a change to the pre-denial process for urgent requests. Click here for additional information. 

                             

                                                                                                                                                                                                      Provider Notification PN181120-002

 

Provider Notice 11/20/2018 - Changes in Prior Authorization Requirements

Effective January 1, 2019, there will be changes in Aetna Better Health of Ohio's prior authorization requirements. Click here to see a full list of Home Healthcare CPT codes that will be effected.

 

Provider Notification PN181120-001

Provider Notice 11/15/2018 - Medicaid Claim Rework Project

Dear Providers,

 

Aetna Better Health of Ohio wanted to notify you that, in a recent claims projects where there was a Medicare and Medicaid eligible payment, some claims projects only reprocessed the Medicare claim and not the Medicaid claim, leaving the provider with a new Medicare payment, but the original Medicaid payment. 

 

We are in the process of having the Medicaid claims associated with this issue reversed and reprocessed against the new Medicare claim associated with those projects. You may notice some Medicaid claim reversals and repayments as a result on future remits.  The reversal and corresponding reprocessed Medicaid claim may not appear on the same remit, but will be done in close proximity.

 

Some of the new Medicaid claims may result in a net recoupment, while others in a net payment. We do not anticipate a significant net difference in payment since the primary payment has been made, and the original Medicaid payment was not reversed during the original projects. We anticipate all of the claims effected to be reprocessed and a new Medicaid payment adjudicated in our system by 12/7/18.   

 

PLEASE NOTE: This would not affect any claim that is only eligible for Medicaid payment.   Should you have any questions, please contact Provider Services at 1-855-364-0974.

 

We appreciate your business.

 

Sincerely,

Provider Services

Aetna Better Health of Ohio

Provider Notification PN181115-001

Provider Notice 11/09/2018 - Ambulatory Surgery Center (ASC) and Acute Hospital EAPG Billing

Aetna Better Health of Ohio would like to clarify that Ambulatory Surgery Centers may not submit claims on a UB04 form using bill type 83X. Click here to read more.

Provider Notification PN181109-001

Provider Notice 9/28/2018 - Updates to Evaluation & Management (E&M) Code Billing

Aetna Better Health of Ohio continues its commitment to correct coding and the implementation of programs that support nationally recognized and accepted coding policies and practices. Evaluation and Management (E&M) coding is an area that the Centers for Medicare & Medicaid Services (CMS) has identified as having significant error rates. Click here to read more.

Provider Notification PN180928-001

Provider Notice 9/12/2018 - Invalid Diagnosis Codes

Aetna Better Health of Ohio recently identified an issue where our claims encounter data was rejecting due to invalid diagnosis codes. Click here to read more.

Provider Notification PN180912-001

Provider Notice 7/30/2018

For your convenience we are redistributing a communication from the Ohio Department of Medicaid regarding the Electronic Visit Verification (EVV) system. Click here to read the full notice.

Provider Notification PN180730-001

Provider Notice 7/25/2018

Effective August 25, 2018 Aetna Better Health of Ohio, for all lines of business, will require prior authorization for certain CPT/HCPCS codes before services are rendered. Read our full notice here.

Provider Notification PN180725-001

Provider Notice 7/3/2018

Effective 10/1/2018 codes not priced on the Aetna Market Fee Schedule will reimburse at 20% of billed charges. Click here to read more.

Provider Notification PN180703-001

Provider Notice 6/8/2018

Skilled Nursing Facility-Direct Schedule with Preferred Transportation Provider.

Provider Notification PN180608-002

Provider Notice 6/8/2018

Outpatient hospital covered services effective July 1, 2018 and August 1, 2018.

Provider Notification PN180608-001

Provider Notice 5/16/2018

Click here to learn about an important update to our policies regarding drug testing.

Provider Notification PN180516-001

Provider Notice 1/25/2018

Click here to learn about Aetna Better Health of Ohio's effort to help close the gap on health disparities for African-Americans who have hypertension.

Provider Notification PN180125-001

Provider Notice 1/22/2018

Effective March 1, 2018 there will be changes in Aetna Better Health of Ohio's prior authorization requirements. Click here to see a full list of CPT codes that will be effected.

Provider Notification PN180122-001

Provider Notice 12/21/2017

Aetna Better Health of Ohio, with our partnership with CMS and Medicaid, continues to address medical cost savings initiatives where appropriate. To stay current with the national coding standards, we are updating our current modifier discount tables to align with those national guidelines. Click here to read the full communication.

Provider Notification PN171221-001

Provider Notice 11/08/2017

the State of Ohio released a revision to several OAC rules pertaining to hospitals. Read this notice to see which rules have been updated.

Provider Notification PN171108-001

Provider Notice 11/02/2017

OhioMHAS will be holding DEA DATA 2000 waiver trainings for physicians, third year resident physicians, physician assistants and nurse practitioners across Ohio. Click here to read more and sign up for one of these trainings.

Provider Notification PN171102-001

Provider Notice 09/25/2017

Help us to ensure that our provider directory is up to date and take this short survey. Your office will also have an opportunity to complete cultural competency accreditation within the survey if you have not already done so.

Click Here to read more

Provider Notification PN170925-001

Provider Notice 09/22/2017

We have updated our dates and times for on-site and online training resources for behavioral health redesign.

Click Here to read more

Provider Notification PN170922-001

Provider Notice 09/14/2017

Our Quality Navigator Team will be hosting two new webinars. You can find out more, and register for one of these webinars by clicking the link below

Click Here to read more

Provider Notification PN170914-001

Provider Notice 09/12/2017

CMS has provided clarification on the guidance for coverage of skilled services in accordance with Jimmo v. Sebelius. Plese click the link below to learn more.

Click Here to read more

Provider Notification PN170912-001

Provider Notice 08/29/2017

In an effort to help ensure your organization and Aetna Better Health of Ohio are prepared for the upcoming Behavioral Health Redesign changes that take effect with the Ohio Department of Medicaid starting on January 1st, 2018 we would like to encourage your organization to participate in a 'claims testing' period.

Click Here to read more

Provider Notification PN170829-001

Provider Notice 07/20/2017

Aetna Better Health of Ohio would like to inform our behavioral health facilities that Medicaid Managed Care Plans may cover IMD services effective 7/1/2017

Click Here to read more

Provider Notification PN170720-001

Provider Notice 05/24/2017

Aetna Better Health of Ohio regularly reviews and analyzes claim handling practices to identify opportunities for improvement. To that end, we are pleased to announce that as of May 31, 2017, we are working with Cotiviti Healthcare (Cotiviti) to assist us with provider claim reviews and reimbursement review practices.

Click Here to read more

Provider Notification PN170524-001

Provider Notice 04/11/2017

Developed by the Centers for Medicare & Medicaid (CMS), the Medicare Outpatient Observation Notice (MOON) serves as the standardized notice used by hospitals and critical access hospital (CAH) to notify Medicare patients who receive more than 24 hours of observation services that their hospital stay is outpatient, not inpatient. You must provide the MOON to these patients no later than 36 hours after services begin.

Click Here to read more

Provider Notification PN170411-001

Provider Notice 04/10/2017

Effective 05/30/2017 Aetna will have the capability to look across claim types and resolve conflicts that may exist between professional and institutional claims.

Click Here to read more

Provider Notification PN170410-001

Provider Notice 04/07/2017

Effective 05/01/2017 Aetna Better Health of Ohio will change the way unlisted and non-specific CPT and HCPCS codes are reviewed and paid.

Click Here to read more

Provider Notification PN170407-001

Provider Notice 01/25/2017

To all participating Skilled Nursing Facilities; Aetna Better Health of Ohio's partnership with Advance Health began on 01/01/2017. If you are interested in attending one of our webinars to familiarize yourself with Advance Health please read this notification and register for one of the trainings today.

Click Here to read

Provider Notification PN170125-001

Provider Notice 12/19/2016

Read this important reminder regarding billing practices.

Provider Notification PN161219-001

Provider Notice 11/02/2016

To Skilled Nursing Facilities: Aetna Better Health of Ohio will be ending its relationship with Optum on 12/31/2016.

Read more.

 Provider Notification PN161102-001

Provider Notice 09/29/2016

Effective 09/29/2016 the Ohio Department of Medicaid will retire procedure code G0154.

Read more.

 Provider Notification PN160929-001

Provider Notice 09/02/2016

Effective 09/26/2016 Aetna Better Health of Ohio members will require prior authorization for Radiology, Cardiology & Pain Management services from eviCore healthcare for dates of service 10/03/2016 and after.

Read more.

Provider Notification PN160902-001

Provider Notice 08/24/2016

Aetna Better Health of Ohio is pleased to release their Home and Community-Based Services Waiver Program Overview Guide. This document is designed to concisely lay out the Waiver Service process, waiver services, and general information about the program.

Read the guide.

Provider Notification PN160824-001

Provider Notice 05/05/2016

All providers who prescribe Part D drugs must be enrolled in Medicare or have validly opted-out of Medicare by February 1st, 2017 in order to continue prescribing Part D drugs to your patients.

Click on one of the links below for full details:

Providers

Pharmacists.

Provider Notification PN160505-001

Provider Notice 03/24/2016

Keeping Your Medicare Advantage Directory Information Up to Date - Aetna Better Health of Ohio contacts you quarterly to ensure that your information in our provider directory is accurate. There's an easier way to make all of your office/facility directory information available to each health plan that your organization participates with using CAQH.

Click Here to learn more.

Provider Notification PN160324-001

Provider Notice 03/18/2016

Important changes have been made to the Aetna Better Health of Ohio Prior Authorization List. Click the link below to read the details.

Prior Authorization Changes - March 2016

Provider Notification PN160318-001

Provider Notice 03/01/2016

If you are a Medicaid-participating provider and have received a Revalidation Notice from the Ohio Department of Medicaid, it means you are approaching the End Date of your Medicaid Provider Agreement.

Click here to read more about ODM’s revalidation process.

IMPORTANT: Failing to respond to ODM’s revalidation request before the Medicaid Agreement End Date could result in termination of the Agreement, and your claims will not be eligible for payment.

Provider Notification P160301-001

Provider Notice 01/12/2016

Aetna Better Health of Ohio has released a chart detailing our standards and timeframes for appointments with our members.

To view the chart, please click here.

Provider Notification PN160112-001

Providers: Not enrolled or properly opted-out of Original Medicare?

Please click the link below to read this important communication from the Centers for Medicare & Medicaid Services if you are a provider who prescribes drugs for Medicare patients and have not enrolled in or properly opted-out of Medicare.

Click Here

Provider Notification PN151016-001

Coming Soon.

Aetna Better Health of Ohio Behavioral Health Redesign Overview Video

Behavioral Health providers can locate the latest updates to the BH Redesign codes, rates and rules on Ohio's official Behavioral Health Redesign page by clicking here.

OAHP Regional Forums Dates and Times

 

Communications