Aetna HMO Plans (California) 888-702-3862 (Benefit Questions or Claim Inquiries) FSA members can check their current account balances by visiting MedBen Access or downloading our mobile app from the Apple App Store or Google Play (search for "MedBen"). This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. Become a Member Enroll Healthy Living Members Send a claim status inquiry We will continue to assist and service claim issues and more complex questions. Reporting and Analytics. If that fails, then contact Simplan customer support at . Read More. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. It doesn't work for HR, Broker, or provider portal accounts. 357 or provideraffairs@medben.com. American Plan Administrators maintains a client roster hailing from respected corporations and industries throughout the United States. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. As a third party administrator with 40 years in the industry PAI has the products, services, and innovative flexibility to cater to all markets. Call to speak to licensed agent now 1 (844) 206-3962 11440 W. Bernardo Court, San Diego CA 92127 American Insurance - auto, health, home and life insurance provider. Zenith American Solutions claims system offers these key functionalities to support health care benefits management: PPO Re-pricing. Office Locations Corporate Headquarters One Penn Plaza Suite 1410 New York, NY 10119 Long Island Applicable FARS/DFARS apply. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. MedBen Access is also available as a mobile app with the same great features! Go to the American Medical Association Web site. customerservice@ahatpa.com FutureScripts Call 1-888-678-7013 1-888-671-5285 (fax) iEXCHANGE 1-888-444-4617 For behavioral health services, please call the phone number listed on the patient's AmeriHealth Administrators ID card. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). Each main plan type has more than one subtype. Our team designs the plan and writes the plan document. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. We're making it more convenient to obtain basic claims status/inquiries. Thrivent will also accept notice from the Thrivent financial professional or the spouse of the insured. If you are calling to verify your patient's benefits*, please have a copy of the member's ID card easily accessible. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Our team of professionals is dedicated to working within your business's unique needs to provide benefits that are easy-to-manage, flexible and tailor-made for your company. MedBen is pleased to have you as a wellness partner. What if I dont agree with how the claim was paid/denied? Customer response . Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. The PEAR portal offers participating providers a single point of entry to multiple digital tools, including PEAR Practice Management, PEAR Comprehensive Visit, and PEAR Analytics & Reporting. 800-566-9311. We manage all self-funded administrative needs including: Enrollment & Eligibility. This field is for validation purposes and should be left unchanged. The new PAI provider portal is going live. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Target high-cost medical treatments, such as kidney dialysis. Include the following (if possible): This information will help us to duplicate and troubleshoot the malfunction you are experiencing. KHN and California Healthline staff made the rounds on national and local media this week to discuss their stories. For assistance with password resets for these accounts, contact Simplan customer service at . We specialize in providing companies and employees with financially healthier wellness and healthcare options. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. To determine whether patients' healthcare plans cover specific services, what their co-pays are, or to obtain details about precertification requirements, contact payers who administer the patients' healthcare plans. Questions about claims status, appeals and payments, authorization and general coding (not how to bill). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Seamless group administration for the employer and employee on all group supplemental products, such as GAP, Dental, Hospital Indemnity, and Limited Benefit plans. read more. Resources. Starting April 1, 2020, we will guide providers to use the Aetna Voice Advantage or our provider portal for basic claim status/inquires. For government programs claims, if you do not have online access, you may call provider customer service to check claim status or make an adjustment. Is there a time limit for filing Medicare supplement claims? This allows our clients more time to spend on their business and less time spent on benefits administration. This search will use the five-tier subtype. View member benefit and coverage information. Chattanooga, TN 37422. Log in to get started! The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Others have four tiers, three tiers or two tiers. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. If that fails, then contact Simplan customer support at . Retrieve member plan documents. * For practitioner and ancillary services only-for facilities, the member's plan is using a Medicare reimbursement-based model . CIGNA Payer ID 62308. On an ongoing basis, we process claims and manage eligibility. HealthComp is a third party administrator (TPA) committed to making access to healthcare easier, more affordable, and simpler for everyone involved. Specialists between 8 a.m. and 4:30 p.m. (CST) Monday through Fridays at 800-650-6497. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Claims administration service is the core of self-funding. We provide customized full service offerings including but not limited to: Reference based pricing options. Follow these instructions to add the benefits portal to your mobile device home screen. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. Email Addresses. Log in to: view the status of claims; . Texas STAR, CHIP 1-877-560-8055. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Log in to Member Portal Medical claim forms Dental claim forms Request ID cards Claim . We have provided self-service tools that allow providers and their representatives to pull basic claim status at their own convenience. Contact UsSitemapPrivacy. Find out how KBA can help you get more from your benefit plan by contacting us today! The payers listed below also provide claims, eligibility and/or benefits information online: Allied Benefit Systems. 1-888-583-3057: Staffmark: 1-866-798-0803: Contact Us If you are a member and have a question on your health plan or Member Portal, please contact Customer Service at the phone number on your ID card or sign in . Contact Us. No Yes 1-800-222-APWU Log In or Register Comprehensive, affordable health benefits for postal workers, federal employees and retirees. Oklahoma Office 3817 NW Expressway, Suite 810, Oklahoma City, OK 73112 (800) 850-7166 This information is neither an offer of coverage nor medical advice. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Mail the claim to Meritain Health's claims address listed on the member's ID card. Use these convenient links for finding FSA-eligible products and calculating your FSA tax savings. If you are having trouble logging into an existing account on the Simplan benefits portal, try the password recovery tool. Broker benefits Get in . Disclaimer of Warranties and Liabilities. Treating providers are solely responsible for medical advice and treatment of members. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). If you do not intend to leave our site, close this message. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Download it from the Apple App Store or Google Play (search for "MedBen"). Links to various non-Aetna sites are provided for your convenience only. AMA Insurance Provider Portal. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Copyright 2015 by the American Society of Addiction Medicine. Yes, there . Print a temporary ID cards. Simplan is there every step of the way with our expertise and tried and true practices and strategies. View your healthcare claims and deductible/out of pocket balances. You can also contact us through our email form. Home; About; Advantages; Solutions/Services; Resources; Contact us Aetna credentialing phone number. For benefit questions, log into your benefits portal account. In case of a conflict between your plan documents and this information, the plan documents will govern. Dozens of charts, graphs and tables, instantly generated. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 47 offices nationwide. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Both American Benefit Plan Administrators and Zenith Administrators were strong TPA's prior to the merger, but by combining . Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. 1-800-303-5242. Get medical and dental patient benefits, claim status updates, EOBs and precertified vision claim forms faxed to you. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). Aetna meritain claims address and Phone number. If you cant find the information you need on our benefits portal website, contact Simplan customer service by phone at, weekdays between 8AM and 5PM CST or by email at customerservice@thesimplan.com. Employers will receive monthly reports detailing your benefit usage which assists in effective plan benefit design and monitoring. APWU Health Plan Claim Status Inquiry ARE YOU AN APWU BARGAINING UNIT EMPLOYEE? ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. requests and multiple attempts by care providers to get claims settled . Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. To the right you will find some "quick links" to some of our more utilized resources. MedBen Access enables you to: If you need assistance logging in to MedBen Access or using its features, please contact MedBen Customer Service at 800-686-8425. Connecting tomorrow with today Submit the claim form via fax or mail: Fax the form to 800-225-2264, attention Disability Claims, or. For general inquiries, please contact Simplan Customer Service at weekdays between 8AM and 5PM CST or use our email form. Our experienced customer service team provides answers and support to plan members. Health Savings Administrators; American Plan Adminstrators (current . Check out the self-service tools to get basic claim status/inquiries, Please be sure to add a 1 before your mobile number, ex: 19876543210, Precertification lists and CPT code search, OfficeLink Updates Newsletters Latest News for your Medical Office. KBA is at your service Monday through Friday from 8:00 am to 7:00 pm Eastern time. Within minutes, the information you need will be faxed to you. STAR Kids 1-877-784-6802. Download a list of participating pharmacies, discount stores and supermarkets that do not use IIAS, but 90% of whose sales come from medical care items (thus making them FSA-eligible). Your benefits plan determines coverage. Check Claims Status Member Eligibility Lookup If you are on your desktop or laptop pc, scan the codes below with your mobile phones QR code scanner app to be taken directly to the app install page on the App Store or Google Play store. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. American Insurance Administrators 1200 Wilshire Blvd-5th Floor Los Angeles, CA 90017-1906 1-800-303-5242. If you cant find the information you need on our benefits portal website, contact Simplan customer service by phone at , weekdays between 8AM and 5PM CST or by email at customerservice@thesimplan.com. Fill out and submit an on-line HCFA UB-92 claim form. About Us; Products. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. The original entity of Zenith American Solutions has been in business since 1944. When billing, you must use the most appropriate code as of the effective date of the submission. Providers: Click here to view claims information. We offer suggestions to control costs while maximizing your benefits. If you are encountering problems with creating an account on our benefits portal website, refer to this online guide. Once added to your home screen, you can launch the web portal just like you would any app. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. to save time and effort for providers: Employee eligibility verification. The information you will be accessing is provided by another organization or vendor. El Paso, TX 79998-1107. 4351 Mapleshade Ln, Suite 300 Plano, TX 75093, Copyright 2022 Simplan For the PHCS Network, 1-800-922-4362 For PHCS Healthy Directions, 1-800-678-7427 For the MultiPlan Network, 1-888-342-7427 For the HealthEOS Network, 1-800-279-9776 For language assistance, please call 1-866-981-7427 For TTY/TTD service, please call 1-866-918-7427 Search for a provider > Company Careers Investors Leadership News There you can browse all you like to see your claims and enrollment status. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. To this end, we are always looking to deliver more efficient solutions to meet your needs. I'm a Broker. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. For additional details, refer to the Claims Caller Guide. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. If you need to get in touch with us, use the Contact Us . Simply call 800-455-9528 or 740-522-1593 and provide: Within minutes, the information you need will be faxed to you. MedBen e-briefs is published bi-weekly. Do you want to continue? You can be assured that only the highest-rated and most trusted insurance companies will be providing your family with the healthcare options they need to stay healthy and productive. Medical claims can be sent to: Insurance Benefit Administrators, c/o Zelis, Box 247, Alpharetta, GA, 30009-0247; EDI Payor ID: 07689. Machine Readable Files (MRFs) hosted by Healthcare Bluebook - No login required: Click here to view Machine Readable Files. In order to complete registration . To report error messages and technical malfunctions with the Simplan benefits portal website, email websupport@thesimplan.com detailing the error or problem you are encountering. Aetna, Inc. P O Box 981107. Applicable FARS/DFARS apply. Medical Management. Our financial, clinical, risk and savings reports show you what is working with your plan while highlighting areas of potential improvement. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. The member's benefit plan determines coverage. Download a list of participating pharmacies, discount stores and supermarkets that can identify FSA-eligible items at checkout using an Inventory Information Approval System (IIAS). While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. As a member of American Plan Administrators, we greatly value the health and well-being of you and your loved ones. And were equally committed to giving you fast and accurate claims processing. I am a: * STEP 2 Your Information Name * Phone * Email * Address 1 Address Line 2 City State Zip Code *Required fields If you are a human seeing this field, please leave it empty. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Thanks! See deductibles, out-of-pocket costs and calendar maximums, Look up drug information, compare local pharmacy prices and check availability of lower-cost equivalents, Check wellness exam and screenings compliance (for WellLiving members). What is the difference between basic claim status/inquiry and claim issues? Visit site Providers - Group Administrators 953 American Lane, Suite 100 Schaumburg, IL 60173 Phone: (847) 519-1880 Toll-Free: (800) 323-1683 [email protected] Visit site American Insurance Administrators The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). Please do not submit any PHI through this form. You can call us at800-331-4757during these hours to speak to one of our friendly and knowledgeable customer service representatives. The Simplan benefits portal website is designed to be mobile-friendly and can be added to your mobile devices home screen. You will be contacted by Insurance Benefit Administrators regarding final pricing for the claims submitted in the weeks following submission. Simply call 800-455-9528 or 740-522-1593 and provide:. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 4351 Mapleshade Ln, Suite 300 Plano, TX 75093, Copyright 2022 Simplan Access medical and pharmacy policies as well as clinical practice guidelines and information about services that require preapproval. Simplan is there every step of the way with our expertise and tried and true practices and strategies. Welcome Providers! Members: Click here to view claims information. You can also contact us through our email form. Still have questions? Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Providers receive fair reimbursement by using Medicare pricing as the primary source of repricing. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. 1200 WILSHIRE BLVD-5TH FLOOR. Providers affiliated with American Plan Administrators have access to vital information at the click of a button, as we maintain a sophisticated internet portal that allows for a plethora of management options. About Us. HMO Based Plans (California) 800-624-0756. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Interested in MedBen e-briefs? Available Resources: Login or create an account to view and maintain your health plan information. Visit the secure website, available through www.aetna.com, for more information. KBA National Headquarters 8330 Allison Pointe Trail Indianapolis, IN 46250 800-331-4757 KBA National Service Center 360 Kingsley Park Drive, Suite 200 Fort Mill, SC 29715 803-396-4600 The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Some subtypes have five tiers of coverage. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. 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