Aetna Claim Form 1500

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Aetna Copy Of Claim 1500 Form Fill and Sign Printable

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8 hours ago Find the Aetna Copy Of Claim 1500 Form you require. Open it up using the cloud-based editor and begin altering. Fill out the blank areas; concerned parties names, addresses and numbers etc. Customize the blanks with smart fillable fields. Include the day/time and place your electronic signature. Click Done after twice-checking all the data.

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Billing and Claims Aetna

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7 hours ago ©2018 Aetna Inc. 3 Proprietary. Before we get started: Basic Concepts. The two most common claim forms are the CMS -1500 and the UB -04. The. UB-04 (CMS 1450) is a claim form used by hospitals, nursing facilities, in -patient, and other facility providers. A specific facility provider of service may also utilize this type of form. The. HCFA-1500

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Electronic Claims Submission Aetna

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7 hours ago CMS 1500 form – likely to be supported on the providers claim submission software. This is the “Relationship Code”, “Insurance Plan Name or Program Name”, “Insured’s Policy Group or FECA Number”, “Insurance Type Code” (Form Locator 1) and “Claim Filing Indicator” (Form Locator 1) from the previous payer. Adjustment codes and

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Provider Claims & Reimbursement Aetna

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Just Now This will be the claim form that will be used for these provider types. These provider types are not use the UB-92 or CMS-1500 forms. Reminder- Timely Filing of Claim Submissions In accordance with contractual obligations, claims for services provided to an enrollee must be received in a timely manner. Our timely filing limitations are as follows:

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Medical Claim Form Aetna

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5 hours ago note: incomplete claim forms will be returned to you for missing information. this will delay the processing of the claim. for faster, easier submission of claims, the provider may contact the aetna claim processing center for information regarding electronic claim submissions. to the employee 1. complete items one (1) through twenty-one (21

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Provider Disclosure Form Aetna

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800-927-43578 hours ago Insurance at 1-800-927-4357, as applicable, to report any inaccuracy with Aetna’s provider directory. CLAIM SETTLEMENTS Clean Claim A clean claim submitted on paper or on its electronic equivalent must be on a CMS-1500 form or a UB-04 form and must include all information and attachments listed.

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Health Insurance Forms for Individuals & Families Aetna

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3 hours ago In that case, complete the claim form and mail it to the address on the claim form. As a result, Aetna will not be mailing Form 1095-B for the reporting tax year. For those that previously received their Form 1095-B in the mail, you can receive a copy of your Form 1095-B by going out to the Aetna Member Website in the “Message Center

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Forms and applications for Health care professionals Aetna

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3 hours ago Commercial Prescription Drug Claim form — Spanish (PDF) Prescription Medication Medical Exception/Precertification request (PDF) Opioid addiction treatment: For Aetna commercial plans, there is no precertification required for buprenorphine products. Part D …

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Aetna Medicare Medical Claim Form & Instructions

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9 hours ago prescription drug claim form. How to fill out this form? 1. Complete each section. Print clearly in black ink only or type the information in the form online. 2. Sign and date the bottom of the comple ted form. Appointed representatives must have an Appointment of Representative form on file with the health plan, or you can submit one with this

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Claims, Payment & Reimbursement – Health Care Aetna

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1 hours ago Instead of a plastic ID card, your patients may give your office: Photocopy or printed version of ID card. Electronic version of ID card, shown on a smartphone or tablet. Please accept these alternate formats. You can get a patient's digital member ID card by submitting an eligibility inquiry on our secure provider website, or through Availity.

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SAMPLE Aetna

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4 hours ago sample please print or type approved omb-0938-1197 form 1500 (02-12)

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EPSDT Billing Instructions Aetna

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6 hours ago AETNA BETTER HEALTH® EPSDT billing guide instructions. The purpose of the EPSDT Billing Guide is to assist Aetna Better Health’s providers to bill appropriately using the CMS-1500 Claim Form or electronically using the 837P format. Providers choosing to bill for EPSDT screens using the CMS-1500 Claim Form must bill using all of the

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Claims submission made easy Aetna International

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2 hours ago on the back of your Aetna ID Card. You can also send us a secure email by logging in to www.aetnainternational.com and clicking 'Contact us'. Claims submission made easy This form can be used to submit a claim for medical, dental, vision, or pharmaceutical services. If you're filing a claim for more than one person, a

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Free fillable CMS medical claim FORM 1500 template with

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3 hours ago The CMS-1500 form is the standard paper claim form used by a non-institutional provider or supplier to bill Medicare carriers and Medicare administrative contractors (MACs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims.

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Forms Aetna

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4 hours ago CMS 1500 Form. Prior Authorization Form (see attached Prior Authorization List) BH Prior Authorization Form Provider Pharmacy Coverage Determination Form (updated 4/14/2021) Par Provider Dispute Form . Non-Par Provider Appeal Form Electronic Funds Transfer form Electronic Remittance Advice form. Ohio Department of Job and Family Services (ODJFS

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Instructions for Completing the CMS 1500 Claim Form

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4 hours ago Instructions for Completing the CMS 1500 Claim Form The Center of Medicaid and Medicare Services (CMS) form 1500 must be used to bill SFHP for medical services. The form is used by Physicians and Allied Health Professionals to submit claims for medical services. All items must be completed unless otherwise noted in these instructions.

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National Uniform Claim Committee CMS1500 Claim

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9 hours ago The 1500 Health Insurance Claim Form (1500 Claim Form) answers the needs of many health care payers. It is the basic paper claim form prescribed by many payers for claims submitted by physicians, other providers, and suppliers, and in some cases, for ambulance services.

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CMS1500 CMS

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1 hours ago CMS-1500 CMS Form Number. CMS-1500. Date. 2019-09-12. Subject. Health Insurance Common Claims Form. Downloads. CMS-1500 (ZIP) Home A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244. CMS & HHS Websites [CMS Global Footer] Medicare.gov; Medicaid.gov

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CMS 1500 blocks instructions in Medical Billing Form 1

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3 hours ago CMS 1500 Form: CMS 1500 Form also known as HCFA 1500 and has 33 blocks. This form is used by providers to submit a claim to the insurance company for the reimbursement of the health care services rendered to patients.

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HEALTH INSURANCE CLAIM FORM DOL

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8 hours ago APPROVED OMB-093B-1197 FORM CMS-1500 (06-15) OMB No. 1240-0044 Expires: 06/30/2024. Instructions for Completing OWCP-1500 Health Insurance Claim Form For Medical Services Provided Under the FEDERAL EMPLOYEES' COMPENSATION ACT (FECA), the BLACK LUNG BENEFITS ACT (BLBA), and the ENERGY EMPLOYEES OCCUPATIONAL ILLNESS

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Aetna Medicare Reimbursement Form Fill Out and Sign

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9 hours ago Get and Sign Aetna Claim Form 2012-2021 . Full and returned within 180 days of the treatment date. 1. Policyholder (Member) Information – Must be completed. Policy Name Policy Number Member's Name Member's Date of Birth Member Aetna Identification Number (found on the member ID card) Street Address City State/Province Country Postal/ZIP Code Member's Telephone Number Mobile Number …

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Claims submission made easy Aetna International

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1 hours ago the back of your Aetna ID Card. You can also send us a secure email by logging in to . www.aetnainternational.com and clicking 'Contact us'. Claims submission made easy . This form can be used to submit a claim for medical, dental, vision, or pharmaceutical services. If you're filing a claim for more than one person, a

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Medical Claim Form Medical plans administered by Aetna

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859-455-86507 hours ago Please Mail Completed Form To The Address On The Member’s ID Card or fax to 859-455-8650.. HEALTH INSURANCE CLAIM FORM. Please Note: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person.

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Aetna International Claim Form

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Just Now Aetna International Claim Form . Please submit this completed claim form with itemized bills and receipts. A separate claim form is needed for each family member. Please tape small receipts on a full size sheet of paper. Failure to complete all sections of this form may result in claim processing delays. Medical . Dental . Maternity

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Instructions on how to fill out the CMS 1500 Form

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3 hours ago Instructions on how to fill out the CMS 1500 Form o Workers’ Compensation (Type 15); o Black Lung (Type 41); and o Veterans Benefits (Type 42). NOTE: For a paper claim to be considered for Medicare secondary payer benefits, a policy or group number must be entered in this item.In addition, a copy of the primary payer’s explanation of benefits (EOB) notice must be

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Outofnetwork claim submissions made easy Aetna

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4 hours ago For complete terms and conditions, review the claim form. Stay in-network and save on your next visit* Choose an in-network provider . The benefits are clear. When you stay in-network, you save more money and get the full value of your vision benefits. Plus, with Aetna Vision. SM. Preferred Network providers across the nation, you have access to

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CMS1500 Claim Form Instructions JD DME Noridian

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7 hours ago The CMS-1500 Form (Health Insurance Claim Form) is sometimes referred to as the AMA (American Medical Association) form. The CMS-1500 Form is the prescribed form for claims prepared and submitted by physicians or suppliers, whether or not the claims are assigned. It can be purchased in any version required by calling the U.S. Government

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CMS 1500 Claim FormSample HCFA 1500 Claim Form

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1 hours ago The HCFA 1500 claim form, also known as CMS 1500 claim form as well. The CMS 1500 Claim Form is the uniform or standard claim form used by a provider or supplier to bill Medicare and DMERCs (durable medical equipment regional carriers) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of …

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How to Make a Claim Aetna International

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1 hours ago After you submit your completed claim form, you will receive a notification by e-mail to confirm that it has been submitted successfully. How to submit a claim by fax, email or traditonal mail. You can also submit a claim by traditional mail, email or secure fax. Mailing addresses and fax numbers are included on your form for your convenience.

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Professional paper claim form (CMS1500) CMS

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7 hours ago The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims.

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Aetna Medicare Forms And Documents

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7 hours ago Billing and Claims - Aetna. Health (7 days ago) ©2018 Aetna Inc. 3 Proprietary. Before we get started: Basic Concepts. The two most common claim forms are the CMS -1500 and the UB -04. The. UB-04 (CMS 1450) is a claim form used by hospitals, nursing facilities, in -patient, and

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Using resubmission codes (HCFA 1500 claim form: Box 22)

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Just Now Using re-submission codes (HCFA 1500 claim form: Box 22) This article will walk you through the process of editing a claim to show a specific re-submission code in Box 22 before refiling. The default setting for Box 22 on the HCFA 1500 form is "1-Original." There are times that a Payer will request that refiled claims show a specific re

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Form CMS1500 Instructions and Sample Form National

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4 hours ago SAMPLE FORM. Information and Instructions for Form CMS-1500 (02/12) for all insurance companies: CMS-1500: Until March 31, 2014, one can use either the old CMS-1500 claim form (version 08/05, as marked in the lower right hand corner) or the new CMS-1500 (version 02/12), for paper claims submitted to Medicare, BCBS and BHS. Tufts does not want the new form until April 1, 2014.

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What is ID qualifier in CMS 1500 0B, 1B, 1C, 1D, ZZ ON

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Just Now Important: Make sure that your claim software supports the 08-05 version of the 1500 claim form. Reference the 1500 Instruction Manual at Nucc.org for specific details on completing this form. UB-04 Paper Institutional Claim Form (for enumerated providers) UB04 Data Element UB04 Field Locator Billing Provider NPI Form Locator 56 Billing

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Get a Form Allina Health Aetna Medicare

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866-756-55142 hours ago Fax the form to: 1-866-756-5514 Or you can mail the form to: Allina Health Aetna Medicare. P.O Box 7405. London, KY 40702 *If you don’t have a creditable prescription drug coverage for 63 days or more, you may have to pay a late enrollment penalty.

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Cranial Prosthesis Sales Sheet Procedure Code: A9282 or 99199

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9 hours ago Step 2 (Make a claim): Fill out and send Claim Form #1500 to your insurance company. Here’s a list of items you’ll need: • Our Federal Tax ID: #13-3925124 • Procedure Code for the wig from your insurance provider (A9282 and 99199 are the most commonly used codes)

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BECAUSE THIS FORM IS USED BY VARIOUS GOVERNMENT …

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6 hours ago the claim and certifies that the information provided in Blocks 1 through 12 is true, accurate and complete. In the case of a Medicare claim, the patient’s signature authorizes any entity to release to Medicare medical and nonmedical information, including employment status, and whether the person has employer group health

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Paper Claim Tips Aetna Dental

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1 hours ago Use the Aetna Dental claim form ( English or Spanish) or the current ADA claim form. Use the appropriate, current CDT code. Use black ink. Print claim data within the defined boxes on the claim form. Use all capital letters. Use a laser printer for best results. Use white correction tape for corrections. Submit notes on 8½ x 11 paper.

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Aetna Reconsideration Form Fill Out and Sign Printable

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Just Now How to fill out the Aetna reconsideration form 2021 on the web: To start the blank, utilize the Fill & Sign Online button or tick the preview image of the form. The advanced tools of the editor will lead you through the editable PDF template. Enter your official contact and identification details. Apply a check mark to point the choice wherever

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CMS 1500 CMS

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5 hours ago CMS 1500. Form Title. Health Insurance Claim Form. Revision Date. 2012-02-01. O.M.B. # 0938-1197. O.M.B. Expiration Date. 2023-10-31. CMS Manual. N/A. Downloads. CMS-1500 (PDF) Home A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244. CMS & HHS

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Aetna international International Medical Insurance

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5 hours ago For individuals and families. Round the clock support for you and your family. Pre-trip guidance to help with your next move. Access to Aetna's team of clinicians. 24/7 assistance via toll-phone, fax or email. A simple way to pay your premiums online. Get International Health Insurance.

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NPI NPI NUCC

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4 hours ago HEALTH INSURANCE CLAIM FORM 1. MEDICARE MEDICAID TRICARE CHAMPVA OTHER READ BACK OF FORM BEFORE COMPLETING & SIGNING THIS FORM. 12. PATIENT ’S OR AUTHORIZED PERSON S SIGNATURE I authorize the release of any medical or other information necessary APPROVED OMB-0938-0999 FORM CMS-1500 (08/05) 1a. INSURED’S I.D. NUMBER (For Program …

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Claim Form Aetna International Fill and Sign Printable

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9 hours ago Get the Claim Form - Aetna International you want. Open it up with cloud-based editor and begin altering. Complete the empty fields; engaged parties names, addresses and numbers etc. Customize the blanks with unique fillable areas. Include the date and place your e-signature. Click Done following double-checking everything.

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Aetna Medicare Claim Forms Download druglist.info

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8 hours ago Aetna Copy Of Claim 1500 Form - Fill and Sign Printable . Health (8 days ago) Download the ready-made papers to your gadget or print it out as a hard copy. Quickly produce a Aetna Copy Of Claim 1500 Form without having to involve specialists. There are already over 3 million customers taking advantage of our unique catalogue of legal documents.

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Box 10d Claim Codes – Therabill

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7 hours ago Box 10d is used to identify additional information about the patient’s condition or the claim. When required by payers, enter the Condition Code in this field. The Condition Codes approved for use on the 1500 Claim Form are available at www.nucc.org under Code Sets. In Application:

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20SONH0014For Your Doctor Flyer V8

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2 hours ago an Aetna claim form or by using the standard CMS-1500 or UB-04 form and send to: Aetna PO Box 981106 El Paso, TX 79998-1106 . Here’s the Aetna medical ID card your patient should have . Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Enrollment in our plans depends on

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Frequently Asked Questions

What is the phone number for Aetna Insurance claims?

Paper Claims – HMO & PPO Products – Mail claims to: P.O. Claims Inquiries – To confirm the recorded date of claims receipt or to make other inquiries about claims, you may call Aetna at 1-800-624-0756 for Medicare HMO Products / 1-888-MD-Aetna (632-3862) for All Other Products, or contact your clearinghouse vendor.

What is the customer service number for Aetna?

The Customer Service Phone Number of Aetna Medicare is: 1-888-247-1051, (860)-273-0123.

What is the appeal process for Aetna?

Health care providers can use the Aetna dispute and appeal process if they do not agree with a claim or utilization review decision. The process includes: Reconsiderations: Formal reviews of claims reimbursements or coding decisions, or claims that require reprocessing.

What are the benefits of Aetna Health Insurance?

If you have Aetna, and you remain in their network you will be able to save a tremendous amount of money on covered health care services. Aetna offers individual and family health insurance plans that provide both physical and mental health coverage.

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