AETNA BETTER HEALTH OF MICHIGAN MI Health Link
AETNA BETTER HEALTH® OF MICHIGAN MI Health Link Providers Lakeland Health System Payer Conference October 18, 2017
Welcome and Introductions Aetna Better Health of Michigan • Shelia Mc. Intyre, Supervisor Provider Relations • Brian Grcevich, Provider Relations Liaison AETNA BETTER HEALTH Aetna Inc. 2
Our Core Values AETNA BETTER HEALTH Aetna Inc. 3
Our Members – The Center of What We Do Quality Management Provider Relations & Provider Network Member Services & Member Advocates Operations & Enrollment AETNA BETTER HEALTH Appeals & Grievances Medical Management Member Collaborative Services Aetna Inc. 4
Member ID cards New ID cards will be mailed to all new members and whenever a PCP change is made If the member does not have his/her new ID card, providers can obtain enrollment verification via Secure Web Portal at http: //aetnabetterhealth. com/michigan • A temporary ID card can be faxed to a provider’s office by request; o Just call 1 -855 -676 -5772 (TTY 711) o Select Member Services prompt • Members can request a new copy of their card anytime from Member Services AETNA BETTER HEALTH Aetna Inc. 5
Member ID Card (Front View) AETNA BETTER HEALTH Aetna Inc.
Member ID Card (Back View) AETNA BETTER HEALTH Aetna Inc.
Participating Provider Confirmation • Providers Newly Added to the Aetna Better Health of MI Network can be found in our online directory at: • http: //aetnabetterhealth. com/michigan • Newly added providers receive a Welcome Letter and Provider Liaison assignment upon acceptance into the Aetna Better Health of Michigan network • Providers can verify their participation status by calling • 1(855)676 -5772 • Select Provider Services (Select Option 2, then, Option 6) AETNA BETTER HEALTH Aetna Inc. 8
Member eligibility • You can verify member eligibility, PCP assignment, benefits, copays/deductibles through three ways: • Continue to use the State CHAMPS system accessed at www. michigan. gov/medicaid providers(SOURCE OF TRUTH) • Provider portal http: //aetnabetterhealth-michigan. aetna. com/ • Contract your Provider Relations Team if you have difficulties with 1 & 2 above • 1(855)676 -5772 Select Provider Services, (Press Option 2, then Option 1) AETNA BETTER HEALTH Aetna Inc. 9
Paper Claims submission All claims for Aetna Better Health of Michigan should be submitted on the most current claim forms, utilizing correct formats – ICD 10 Effective 10/1/2015 Paper claims submission information for Aetna Better Health of Michigan go to: Paper Claims mailing address Aetna Better Health of Michigan P. O. Box 66215 Phoenix, AZ 85082 -6215 How to fill out a CMS 1500 Form: http: //www, . cms. gov/Regulatins-and-Guidance/Manuals/downloads/clm 104 c 26. pdf Sample CMS 1500 Form: http: //www. coms. gov/Medicare/CMS-Forms/downloads/cms 1500805. pdf How to fill out a CMS UB-04/1450 Form: http: //www. coms. gov/Regulations-and-Guidance/Manuals/downloads/clm 104 c 25. pdf AETNA BETTER HEALTH Aetna Inc.
Electronic/EDI Claims submission information for Aetna Better Health: • Aetna Better Health encourages participating providers to electronically submit claims through Emdeon (Change Health) at http: //www. emdeon. com/ • Please use EDI submitter ID #128 MI when submitting electronic claims. • Emdeon(Change Health) Office Web. Connect is offered at no charge. AETNA BETTER HEALTH Aetna Inc.
Claim status BY PHONE: • • • You can contact Claims Inquiry/Claims Research (CICR at 1(855)676 -5772 (Optin 2, Option 4) BY Provider Portal: • Providers can access the provider portal through a link on the public website at www. aetnabetterhealth. com/michigan Our CICR team will: • Assist with Claims questions, inquiries and reconsiderations • Review claims or remittance advices • Assist with claim related prior authorization questions • View recent updates Locate forms • Find a participating provider or specialist • Assist with changes to a practice • (locations, provider termination, etc. ) AETNA BETTER HEALTH Aetna Inc.
Claim resubmissions and reconsiderations • Resubmitted claims must be submitted as a New Claim and can be submitted electronically • Label all corrected claims as “Corrected Claim” on the claim form • Submit all claim lines, not just the line being corrected • Send paper claims for reconsideration with attached documentation to: • Aetna Better Health of Michigan • P. O. Box 66215 • Phoenix, AZ 85082 -6215 • Please download and use the Participating Provider Dispute Form on our website www. aetnabetterhealth. com/michigan AETNA BETTER HEALTH Aetna Inc. 13
Remittance advice • Remittance advices are located within the Aetna Better Health of Michigan new provider portal http: //aetnabetterhealth. com/michigan • Electronic Remittance Advice (ERA) are available via your electronic vendor/clearinghouse, if applicable • Claims and remit information will remain available on our provider portal for up to three (3) years AETNA BETTER HEALTH Aetna Inc. 14
Remittance advice AETNA BETTER HEALTH Aetna Inc. 15
Electronic tools TWO (2) Enrollment Options for EFT/ERA • Online through our Secure Web Portal Electronic remittance advice (ERA-835 files)/Electronic funds transfer (EFT) • http: //aetnabetterhealth. com/michigan • Call Provider Relations at 1(855)676 -5772 ( Option 2, then Option 6) AETNA BETTER HEALTH • • Electronic Remittance advice(s) are only available online for providers who signed up for EFT and ERA; all other providers will receive a paper RA Providers who do not sign up for EFT will receive paper checks You should work with your clearinghouse to ensure you can receive ERA and have the correct file paths. Aetna Inc. 16
Prior Authorization options List of Prior Authorization Services (Partial): • Inpatient Services • Long term support services • Surgical services • Therapy • Imaging • Durable Medical Equipment • Dental (select services) • Injectable • Orthotics/Prosthetics • Transportation • For a Complete list of Prior Authorization Services, go to the Provider Portal at http: //aetnabetterhealth. com/michigan then select “Pro. Pat Auth Lookup Tool” AETNA BETTER HEALTH Aetna Inc. 17
Medical Prior Authorization Secure Web Portal (Only for Network Providers) Fax Phone 1 -855 -365 -8108 1 -855 -676 -5772 High Tech Radiology Authorizations Pharmacy Authorizations Med. Solutions/evi. Core: - By Phone: Caremark. CVS: - By phone: • 1(888)693 -3211 • • 1(855)676 -5772 (Option 2, Option 2) 1(888)624 -1135(CVS Caremark) - By fax: 1(844) 242 -0914 (CVS Caremark) NOTE: A current list of services which require prior authorization can be found online at http: //aetnabetterhealth. com/michigan. AETNA BETTER HEALTH Aetna Inc.
Member Services can help with: • Eligibility and benefits • Assisting members with available programs and resources • Assisting members in finding providers • Assisting members in filing grievances or appeals • Call Member Services at 1(855)676 -5772(Option 1) AETNA BETTER HEALTH Aetna Inc.
Provider Relations Our provider Relations staff is available to you Monday through Friday 8 AM 5 PM to assist you on any facets of your relationship with Aetna Better Health of Michigan. You can reach Provider Relations BY: • PHONE: Provider Relations Phone – 1(855)676 -5772 (Option 2 then Option 6) • EMAIL: E-mail: Aetna. Better. Health-MI-Provider. Services@aetna. com • FAX: Provider Relations – 1(844)300 -7473 • Your Aetna Provider Relations Liaison • Brian Grcevich • PH#: (269)251 -3243 • Email Address: Grcevich. B@aetna. com AETNA BETTER HEALTH MO-15 -05 -13 Aetna Inc.
Provider Manual The Aetna Better Health of Michigan Provider Manual will be available. You can find it online at www. aetnabetterhealth. com/michigan. In addition to policies and procedures, this resource includes: • Important contact information • Provider rights and responsibilities • Credentialing • Member eligibility and enrollment • Billing and claims • Reconsiderations, appeals and complaints • Utilization Management Program and requirements • Quality Improvement Program AETNA BETTER HEALTH Aetna Inc. 21
Provider portal The Secure provider web portal will allow Aetna Better Health of Michigan providers to: • Search member eligibility and verify enrollment • Search and initiate authorizations (Care. Web. QI) • Search claims status • View claim detail, explanation of benefits and remittance advice • View provider lists and panel roster • Contact the health plan via secure messaging • Review HEDIS gaps in care AETNA BETTER HEALTH Provider portal access • Providers can access the new provider portal at www. aetnabetterhealth. com/michigan Aetna Inc. 22
Provider portal registration • Providers should register for the provider web portal. To get started: – Complete the web portal registration form – Submit web portal registration form to Provider Relations – Review our provider web portal navigation guide – If you’d like help registering or would like a demonstration, contact Provider Relations at 1 –(855)676 -5772 (Option 2, then Option 6) – Each TIN will have one account, with a primary administrator. – The primary representative can add authorized representatives within their office to their account Don’t forget to register for the provider web portal. If you have questions, call Provider Relations at 1 (855)676 -5772. AETNA BETTER HEALTH Aetna Inc. 23
Public website Members and providers can access the Aetna Better Health of Michigan website at www. aetnabetterhealth. com/mi. Through the website, providers will be able to access: ─ The secure provider web portal ─ Our provider manual, communications and newsletters ─ A searchable provider directory ─ A Reconsideration form ─ Clinical practice guidelines ─ Member materials ─ Fraud & abuse information and reporting ─ Information on reconsideration and provider appeals AETNA BETTER HEALTH Aetna Inc. 24
Provider Services Department CLAIMS PRIOR AUTHORIZATION PROVIDER SERVICES Option 2, then Option 4 then Option 5 then Option 6 E-Mail: Aetna. Better. Health-MIProvider. Services@aetna. com www. aetnabetterhealth. com/michigan AETNA BETTER HEALTH Aetna Inc.
Grievance and Appeals Provider Grievances (Complaints) Must be received within one (1) year of the date of the incident and should include the remit date or date of notice of action that caused the complaint • The complaint should be clearly marked as a “Complaint” on the letter Provider Appeals • Provider appeals must be received via Fax or Mail within ninety (90) days of the action taken by Aetna Better Health of Michigan, giving rise to the appeal • • The appeal letter should clearly note you are filing an “Appeal” on the letter • All documents to support the appeal should be provided, such as a copy of the claim, remittance advice, medical review sheet, medical records, and other correspondence • By Fax: 1(866) 889 -7517 • By Mail: Aetna Better Health of Michigan • Attn: Provider Appeals • 1333 Gratiot Avenue, Suite 400 • Detroit, MI 48207 AETNA BETTER HEALTH • Decision response • • - Pre-service: within 35 calendar days - Post service: within 35 calendar days • Appeal is reviewed by a physician not involved in original decision and not subordinate to original decision marker The Appeal decision is the final decision • • • Member Appeals Member authorization is required to appeal on behalf of a member (preservice) Aetna Inc. 26
Questions? AETNA BETTER HEALTH MO-15 -05 -13 Aetna Inc.
Thank you AETNA BETTER HEALTH MO-15 -05 -13 Aetna Inc.
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