Tag: Availity
Aetna OfficeLink Updates 9/1/2021
Aetna is going paperless. Here is how to get your electronic EOB Statements and Payments.
Starting in September through 2022, we’re phasing out paper Explanation of Benefits (EOB) statements and checks. Sign up before it’s your turn. If you don’t enroll to receive direct deposit payments, you may receive future payments by virtual credit card. Keep reading to learn more.
Get EOB statements from Availity®
Register for our provider portal on Availity. Get identical copies of your EOB statements from the Availity Remittance Viewer. Then print or save them to your computer. You won’t need to wait for them to arrive in the mail.
Sign up for direct deposit payments
Sign up for direct deposit payments using our new portal, Payer Enrollment Services. Just goto Payer Enroll Services. We’ll stop using EnrollHub® effective September 1. Even if you’re
already enrolled to receive direct deposit payments (or electronic remittance advice), use the new portal to make changes.
Visit AetnaPaperlessOffice to learn more about your options
Third Party Claim and Code Review Program
Beginning December 1, 2021, you may see new claim edits. These are part of our Third Party Claim and Code Review Program. These edits support our continuing effort to process claims accurately for our commercial and Medicare members. You can view these edits on our provider portal.
We may request medical records for certain claims, such as high-dollar claims, implant claims and bundled-services claims, to help confirm coding accuracy.
You’ll have access to our prospective claims editing disclosure tool. To find out if our new claim edits will apply to your claim, log in to the Availity provider portal. Once there, go to Aetna’s Payer Space > Applications > Code Edit Lookup Tools. You’ll need to know your Aetna® provider ID number (PIN) to use the tools.
For all coding changes, go to Aetna Payer Space > Resources > Expanded Claim Edits
Performance Blues (BCBS)
Has Performance given you the Blues?
I mean the Blue Cross Blues.
If you end up among the physicians covered in a wide-ranging quality program launched by Blue Cross Blue Shield of Texas (BCBSTX), you’ll get to see your score for the first time next month.
What’s that score going to look like?
PEAQ Performance: Blues Program Shows Little Progress in Addressing Physicians’ Concerns 06/2021
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2021/06/PEAQ-Performance-Blues-Program-Shows-Little-Progress-in-Addressing-Physicians-Concerns-2021.06.pdf” download=”all” viewer=”google”]
News from Aetna
Check out the news from Aetna regarding: (click)
- Changes to their National Precertification
List (NPL) - Submitting precertification requests
- How to use Availity to request precertification online
News from Aetna, April 15, 2021
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2021/04/News-from-Aetna-2021.04.15.pdf” download=”all” viewer=”google”]
Aetna Commercial Drug Changes
Changes to Aetna's Commercial Drug Lists
On July 1, 2021, Aetna will update their pharmacy drug lists.
You’ll be able to view the changes as early as May 1, 2021. They’ll be available on our Formularies & Pharmacy Clinical Policy Bulletins page.
Ways to request a drug prior authorization
- Submit your completed request form through our provider portal on Availity
- For requests for nonspecialty drugs on Aetna Funding Advant age5M , Premier, Premier Plus, Small Group ACA and Value Plus plans, call the Precertification Unit at 1-855-240-0535 (TTY: 711). Or fax your completed prior authorization request form to 1-877-269-9916.
- For requests for nonspecialty drugs on the Advanced Control, Advanced Control – Aetna, Standard Opt Out, Standard Opt Out – Aetna, Standard Opt Out with ACSF, Aetna Health Exchange and High Value formulary plans, call the Precertification Unit at 1-800-294-5979 (TTY: 711). Or fax your completed prior authorization request form to 1-888-836-0730.
- For requests for drugs on the Aetna Specialty Drug List, call the Precertification Unit at 1-866-814- 5506 (TTY: 711). Or fax your completed prior authorization request form to 1-866-249-6155.
These changes will affect all drug lists, precertification, quantity limits and step-therapy programs. For more information, call the Provider Help Line at 1-800-238-6279 (TTY: 711) (1-800-AETNA RX).
Aetna Authorization Changes
Changes to Aetna National Precertification List (NPL)
As published in the March 1, 2021, edition of Aetna Officelink Updates™
As of July 1, 2021, these precertification changes apply:
- We’ll require precertification for:
- Cataract surgery
- Sacroiliac joint fusion surgery
- Knee arthroscopy with meniscectomy
- Vertebral corpectomy procedures
- Additional lower limb prosthetic codes including select foot, ankle and vacuum pump components
- Spinraza® (nusinersen) – precertification required for both the drug and site of care.
Submitting requests
Be sure to submit authorization requests at least two weeks in advance.
To save time, you can make your request online. Doing so is fast, secure and simple. You can submit most requests online through our provider portal on Availity. Or you can use the Electronic Medical Record (EMR) system portal.
Are you asking for drug prior authorization on a specialty drug for a commercial or Medicare member? Then submit your request through Novologix®, also available on Availity®.
Not registered for Availity?
Register online or call 1-800-AVAILITY (1-800-282-4548). For one-on-one support from us, call Aetna at 1-866-752-7021. Then ask to talk with the Availity team.
You can use our “Search by CPT code” search function on our Precertification Lists web page to find out if the code needs precertification.
You can learn more about precertification under the General Information section of the NPL.
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