Doing business with Aetna updates Lakeland Care Payor

Doing business with Aetna updates Lakeland Care Payor Conference David Lucas Network Account Manager

Overview of Aetna Plans • Lakeland Care logo should be on ID card along with the Aetna Logo for all members that live in Berrien & Cass counties. Aetna members outside of these counties will not have the logo but are still in network with Lakeland. • Participation applies to all plans except NAP only Plans. If ‘NAP’ is the only plan type indicator on the front of the ID card, then Lakeland would not be par. • If the ID card has NAP along with another plan type (PPO, Choice POS II, Select, etc) then you are par as the additional plan indicator overrides NAP. Aetna Inc. 2

Accessing Aetna’s Secure Provider Website Two ways to log in for secure access to Aetna member claims, EOBs and more: • https: //navinet. navimedix. com/Main. asp • www. aetna. com Confidential disclaimer or title of presentation here, edit in View/master/slide master Aetna Inc. 3

Aetna’s website for health care professionals www. aetna. com Confidential disclaimer or title of presentation here, edit in View/master/slide master Aetna Inc. 4

Aetna’s secure provider website Contact: 1 -888 -482 -8057 Aetna Inc. 5

Self-service tools and transactions available • • • Account management tools Claim status inquiry Claim submission Eligibility and benefits EFT and ERA enrollment Online EOBs Payment Estimator Precertification Referrals Contact Us Member Eligibility Aetna Inc. 6

Checking Member Eligibility Doing Business with Aetna Inc. 7

Eligibility Details This box shows Product & COB Details Click here to view & Print ID Card Doing Business with Aetna Inc. 8

Accessing Online Member ID Cards Doing Business with Aetna Inc. 9

Precertification Doing Business with Aetna Inc. 10

Precertification Doing Business with Aetna Inc. 11

Precertification Form Doing Business with Aetna Inc. 12

Contact us Two ways to contact us • Aetna Provider Service Line: 888 -632 -3862 • The Contact Us button via Navi. Net which works much like a call to the Provider Service Center and will get your question or claim(s) to the right area to be handled. Doing Business with Aetna Inc. 13

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CONTACT US 16

Additional Education on Navinet Visit: www. aetnaeducation. com Aetna Inc. 17

Aetna’s Provider Webinars Webinar title Webinar description Time Account Management Tools This webinar is ideal for billing staff and billing companies. We cover everything related to patient accounts, including claims submission, claims reports, online Explanations of Benefits (EOBs), single and multiple claims reconsiderations, and our Payment Estimator tool. 30 minutes Precertificati on This webinar is key for anyone managing the precertification process for their practice or facility. We review the Precertification Code Search Tool, and show inpatient and outpatient precertification and behavioral health precertification. We’ll also highlight the Precertification Inquiry and Precertification Status Update tools. 30 minutes Navi. Net Basics This webinar is great for anyone getting started with our secure provider website. We cover registration, the role of the security officer, and review all of the tools and transactions. 60 minutes Aetna Voice Advantage® This webinar is helpful for office staff who prefer to call us. You’ll learn how to quickly and easily navigate our automated phone system to check eligibility, claims status and precertification requirements. 30 minutes Doing Business with Aetna This is a “soup-to-nuts” webinar about working with us. We cover how to contact us, identify our products and discuss all of the tools and transactions available on our secure provider website. 60 minutes Claim EOB and EFT This webinar is perfect for those practices that have just transitioned to full paper suppression of their EOBs or are considering it. We’ll give you a step-by-step review of the electronic EOB tool. Then, we’ll share all of the benefits of using this tool, along with electronic funds transfer (EFT). 30 minutes Doing Business with Aetna Inc. 18

• The ID card will have the payer’s name/logo and Aetna Signature Administrators (ASA) listed as the network. • Benefits, eligibility, and claim status should be verified through the payer/TPA. Please refer to the phone number or website on the ID card. • Claims submission: Claims are submitted directly to the payer. Please use the claims address or payer ID listed on the ID card. • Precertification/Preauthorization: any necessary precertification would be through the payer. Doing Business with Aetna Inc. 19

Doing Cofinity Business with Cofinity Date Updates ALL CONTENT COPYRIGHT © 2009 COFINITY

General Information • Lakeland Care logo should be on ID card for members that live in Berrien & Cass counties along with the Cofinity Logo • Some Cofinity cards may not have Lakeland Logo in this case you will need to check the payor listed on the card. If the payor listed on the card is a contracted Lakeland payor the member will be in network. • Customer Service –eligibility, benefit and claim status are accessed through the payor customer service (number on card) ALL CONTENT COPYRIGHT © 2009 COFINITY

Lakeland Payor Access • • • Aetna/ASA Assurant Health (including John Alden Life & Fortis Benefits) US Health and Life Federated Insurance Group Marketing Services Liberty Union/ M E T Mid America Physicians Health Plan (PHP) Trustmark (including: FHM, Starmark, Coresource, NGS & Nippon Life) Employer Specific – Ciena - Royalton Manor Employer Specific – Lifecare Ambulance Employer Specific – Menasha Corporation ***Some of these payers offer both Cofinity and ASA as the network. It is important to obtain the ID card so you have the correct network/claims address information. ALL CONTENT COPYRIGHT © 2009 COFINITY

Inquiries • Cofinity customer service: 1 -800 -831 -1166 • Customer service will be able to advise claims priced by Cofinity and the payer information (name & phone number) • Reconsiderations & appeals of Cofinity pricing should be sent via fax using Problem Resolution Form or by calling Cofinity Customer Service ALL CONTENT COPYRIGHT © 2009 COFINITY

Claims Mailing Claims mailing address: Cofinity PO Box 2720 Farmington Hills, MI 48333 ALL

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