Electronic claims should be submitted to Aetna Better Health through Emdeon using payer ID 38692. Claims billed using payer ID 38692 come directly to the Medicaid/CHIP claim system.
If your electronic billing vendor is unable to convert to ID 38692, you can have them continue to use the Aetna commercial Payer ID 60054.
For claims processing guidelines, please refer to the provider manual.
A claim appeal is a written request by a provider to give further consideration to a claim reimbursement decision based on the original and or additionally submitted information. The document submitted by the provider must include verbiage including the word “appeal”.
An appeal must meet the following requirements:
- It is a written request to Appeal a claim
- You're now requesting further consideration based on the original and or additionally submitted information
- The document submitted must include verbiage including the word “appeal”.The claim may be appealed in writing by completing an appeal form or by completing the following:
- Aetna Better Health will process appeals and adjudicate the claim within thirty (30) days from the date of receipt. A provider may appeal any disposition of a claim.
- Submit a copy of the Remit/EOB page on which the claim is paid or denied.
- Submit one copy of the Remit/EOB for each claim appealed.
- Circle all appealed claims per Remit/EOB page.
- Identify the reason for the appeal.
- If applicable, indicate the incorrect information and provide the corrected information that should be used to appeal the claim.
- Attach a copy of any supporting documentation that is required or has been requested by Aetna Better Health. Supporting documentation to prove timely filing should be the acceptance report from Aetna Better Health to the provider’s claims clearinghouse. Supporting documentation must be on a separate page and not copied on the opposite side of the Remit/EOB.
Note: It is strongly recommended that providers submitting appeals retain a copy of the documentation being sent.
Please submit your appeals and all supporting documentation to the following address:
Aetna Better Health
Appeals and Correspondence
P.O. Box 569150
Dallas, TX 75356-9150
Verbally by calling:
Medicaid STAR 1-800-248-7767 (Bexar), 1-800-306-8612 (Tarrant)
Medicaid STAR Kids 1-844-STRKIDS (1-844-787-5437)
CHIP or CHIP Perinate 1-866-818-0959 (Bexar), 1-800-245-5380 (Tarrant)
By Email: TXComplaintsandAppeals@AETNA.com
Provider Complaint to HHSC
You can also file a complaint with HHSC by email:
- Information regarding provider complaints and appeals, please refer to the Provider Manual .