How to File a Claim
Aetna Medicare Dual Core (HMO SNP) encourages providers to electronically submit claims, through Emdeon. Please use the following Submitter ID when submitting claims to the health plan: Submitter ID# 38692 for both CMS 1500 and UB 04 forms.
Contact your Provider Services representative for more information on electronic billing.
Or you can mail hard copy claims or resubmissions to:
Aetna Medicare Dual Core (HMO SNP)
PO Box 60938
Phoenix, AZ 85082-4205
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 (coming soon).
Claim Resubmission, Reconsideration and Appeals
Definitions & Helpful Links:
Claim Resubmission (Corrected Claim) – a claim that is resubmitted to Aetna Medicare Dual Core 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 Medicare Dual Core
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.