Information & Resources
Information provided in this section will help you better serve Aetna Better Health members
Important phone numbers
Fraud & abuse
Aetna Better Health of Texas has an aggressive, proactive fraud and abuse program that complies with state and federal regulations. Our program targets areas of health care-related fraud and abuse, including internal fraud, electronic data processing fraud and external fraud.
A Special Investigations Unit (SIU) is a key element of the program. This SIU detects, investigates and reports any suspected or confirmed cases of fraud, abuse or waste to the Office of Inspector General. During the investigation process, the confidentiality of the patient and of people referring the potential fraud or abuse case is maintained.
To report waste, abuse or fraud, choose one of the following:
• Call the OIG Hotline at 1-800-436-6184.
• Visit the Office of the Inspector General and fill out the Fraud, Waste & Abuse form regarding providers or patients you suspect of waste, abuse or fraud.
You can also report directly to Aetna Better Health any providers or clients you suspect of waste, abuse or fraud.Aetna Better HealthAttention: SIU CoordinatorPO Box 569150Dallas, TX 75356-9150
For more information on Aetna Better Health Fraud, Waste, and Abuse program, refer to the Provider Manual.
All patient identifiable information must meet the confidentiality regulations as specified by the Health Insurance Portability and Accountability Act (HIPAA) guidelines.
Aetna Better Health network providers must treat all information that is obtained through the performance of health services as confidential information to the extent that confidential treatment is provided under state and federal laws, rules and regulations. This includes, but is not limited to, information relating to applicants or recipients of HHSC Programs.
Member rights and responsibilities
It is widely known that providing primary prevention services, such childhood immunizations, can reduce the incidence of illness, disease and accidents. Secondary prevention services, such as early detection of potentially serious illnesses, may reduce the impact of the illness on the patient, thereby decreasing the cost of care. Each primary care office visit should be viewed as the only opportunity for a comprehensive assessment of the member’s health status.
We encourage providers delivering well-child care to Aetna Better Health CHIP members to use the American Academy of Pediatrics (AAP) Preventive Health Guidelines
The Aetna Better Health Provider Relations team strives to make it easy to do business with us. The team is available Monday through Friday, from 8 a.m. to 5 p.m.
Our Provider Relations representatives are responsible for the overall management of the Aetna Better Health Network. The team will work to:
- Educate providers on administrative policies and procedures
- Communicate changes and updates that assist providers in the efficient administration of our plans
- Advocate on behalf of our providers to resolve issues
- Manage changes to the demographic information of participating providers
Please contact Provider Relations at:
Medicaid STAR Kids - 1-844-STRKIDS (1-844-787-5437)
Provider Call Center – Our hours of operation for the provider hotline is Monday through Friday, 8:00 a.m. to 5:00 p.m. Central time, excluding State-approved holidays. After hours or weekends, please leave a message. Providers also have 24/7/365 day access by utilizing self-service tools such as our interactive voice response (IVR) system and provider portal for eligibility and benefit questions.
Prior authorization is the review of the medical necessity and appropriateness of selected health services before they are provided. Annual review of prior authorization criteria was completed on 2/12/2019.
Refer to the provider manual for more information regarding the prior authorization process.
- Online prior authorization search tool can also be used to determine if prior authorization (PA) is required for services.
- Texas Standard Prior Authorization Request Form for Health Care Services
- Adverse Determination Letter Template
Tips for requesting authorizations:
- ALWAYS verify member eligibility prior to providing services
- Complete all entire form and attach supporting documentation prior to submitting
- Submit the request timely to ensure Prior Authorization staff have 3 business days to complete the review
Remember, a request for prior authorization is not a guarantee of payment. Unauthorized services will not be reimbursed.
To request an authorization, find out what services require authorization or check on the status of an authorization, visit our provider secure web portal. For more information about prior authorization, review your provider manual.
Texas Medicaid & Healthcare Partnership
Texas Medicaid & Healthcare Partnership (TMHP) is a group of contractors under the leadership of Accenture. Accenture administers Texas Medicaid and other state health-care programs on behalf of the Texas Health and Human Services Commission.
Texas Health and Human Services Commission
Texas Health and Human Services Commission (HHSC) works to maintain and improve the health and human services system in Texas and to administer its programs in accordance with the highest standards of customer service and accountability for the effective use of funds.
HHSC oversees the operations of the health and human services system, provides administrative oversight of Texas health and human services programs, and provides direct administration of some programs.
The Department of Family and Protective Services (DFPS) works to protect children, seniors, and people with disabilities from abuse, neglect, and exploitation. It also works to protect the health and wellness of children in daycare and foster care.
You can call the nurse line at:
Medicaid STAR 1-800-248-7767 (Bexar), 1-800-306-8612 (Tarrant)
STAR Kids 1-844 STRKIDS (1-844-787-5437)
CHIP or CHIP Perinate 1-866-818-0959 (Bexar), 1-800-245-5380 (Tarrant)
TTY/TDD - 1-800-735-2989
You can read more about the 24-Hour Nurse Line in the Health & Wellness section of our website.
Texas Health Steps
Texas Health Steps offers FREE continuing education courses designed to help enhance preventive health, mental health, oral health and case management services to children who are Medicaid eligible in Texas.
Learn more and register for an online Texas Health Steps training provided by the Department of State Health Services (DSHS).
STAR Kids training - NEW!
We invite you to participate in the following webinar training sessions. Please select the session that you would like to attend. Send us an email with:
- Your name or facility name
- Contact phone number
- Email address to send webinar information to
- Which session, time and date you want to attend
Adoption Assistance and Permanency Care Assistance program (AAPCA)
On behalf of the Aetna Better Health plan, we would like to welcome both new and existing providers to our Adoption Assistance and Permanency Care Assistance program (AAPCA). We are pleased you have decided to participate with our plan. Effective September 1st, 2017 children and youth in the Adoption Assistance and Permanency Care (AA/PCA) population will align to our STAR or STAR Kids programs.
The Adoption Assistance (AA) program provides help for certain children who are adopted from foster care. The Permanency Care Assistance (PCA) program gives financial support to family members who provide permanent home to children who were in foster care but could not be reunited with their parents.
We ask that you continue to access our Provider Manual for additional information about this program and other plan benefits. If you have additional questions, please refer to our Provider Relations Contact information listed on our Provider website landing page.
For CME credit: After completing the course the physician is sent an email with instructions on claiming CME credit.