Yon lòt gwoup oswa founisè bay enfòmasyon yo nan pwochen paj la. Si w pa swete kite sit nou an, chwazi “X” ki nan pati dwat ki nan kwen ki anwo a pou fèmen mesaj sa a. Oswa chwazi “Kontinye” pou ale ann avan.
Ou Gen Kesyon?
Ou kapab konsilte manyèl pou founisè w la (PDF). Oswa rele sèvis Rlaston Founisè yo nan 1-855-456-9126 (TTY: 711). Nou la pou ou Lendi jiska Vandredi, soti 9 AM rive 5 PM.
Griy tarif ak kòd faktirasyon
Ou kapab jwenn kòd faktirasyon ou bezwen yo pou divès sèvis espesifik nan griy tarif yo.
Pwofesyonèl ki bay swen adomisil ansanm ak pwofesyonèl swen gadri yo dwe soumèt tout reklamasyon yo sou UB 04. Si yon founisè k ap patisipe pa soumèt yo kòmsadwa, yo ka retade oswa refize reklamasyon yo.
You’ll need to fill out a claim form.
You must file claims within 120 days from the date you provided services, unless there’s a contractual exception.
Sou entènèt la
Availity is our provider portal, which provides functionality for the management of patients, claims, authorizations and referrals. To submit claims online via Availity, choose the button labeled “Medicaid Claim Submission – Office Ally.” This link will take you directly to the Office Ally website where you can submit claims using their online claim entry feature or by uploading a claim file.
Providers must have an Office Ally account to submit claims online. Submission of your Aetna Better Health of New York claims using Office Ally is free of charge. The status of claims submitted online should be managed through your Office Ally Account.
La lapòs
Ou kapab voye kopi di reklamasyon yo pa lapòs tou oswa w ka resoumèt yo nan:
Reklamasyon Aetna Better Health yo
PO Box 982972
El Paso, TX 79998-2972
Make reklamsyon ou resoumèt yo klèman avèk “resoumèt” pou w evite yo refize yo poutèt yo double.
You can resubmit a claim through Availity or by mail. If you resubmit by mail, you’ll need to include these documents:
Yon kopi ajou reklamasyon an — tout liy yo dwe refaktire
Yon kopi reklamasyon orijinal la (re-enpresyon oswa yon kopi akseptab)
Yon kopi avi vèsman nou te refize oswa mal peye reklamasyon an pou li a
Yon nòt tou kout ki dekri koreksyon w mande a
Tout lòt dokiman ki obligatwa
Ni founisè ki nan rezo yo ni sa ki pa nan rezo yo gen dwa pou yo konteste rezilta yon desizyon. W ap gen pou soumèt kontestasyon w la alekri nan lespas 60 jou kalandriye apati lè repons re-egzamen an (dat EOB a).
Ou pral resevwa yon lèt desizyon final ki endike desizyon an, jistifikasyon an ansanm ak dat desizyon an. Jeneralman, nou rezoud konfli ant founisè yo nan lespas 30 jou kalandriye.
If the decision of the dispute isn’t in your favor, you can’t “balance bill” the member for services or payment that we denied for coverage.
You can dispute a claim:
By mail
Ou kapab voye kontestasyon w lan nan:
Aetna Better Health of NY - Depatman Relasyon avèk Founisè yo
Atansyon: Dispit avèk Founisè a
101 Park Ave, 15th Floor
New York, NY 10178
Pa faks
Voye plent ou a1-855-264-3822 oswa 1-860-754-9121.
Si pou kèlkeswa rezon an ou pa satisfè de politik, pwosedi nou yo oswa nenpòt aspè nan fonksyon administratif nou yo, ou ka soumèt yon plent. Ou kapab jwenn plis enfòmasyon sou pwosesis plent nou an sou paj plent ak kontestasyon nou an..
Jwenn plis enfòmasyon sou plent yo
Sèvis Enstriksyin EFT/ERA (EERS)
EERS offers our providers a more streamlined way to access payment services. It gives you a standardized method of electronic payment and remittance while also expediting the payee enrollment and verification process.
EFT makes it possible for us to deposit electronic payments directly into your bank account. Some benefits of setting up an EFT include:
- Amelyorasyon koyerans pèman
- Tranzaksyon rapid, ki presi epi ki sekirize
ERA is an electronic file that contains claim payment and remittance info sent to your office. The benefits of an ERA include:
- Rediksyon afichaj manyèl enfòmasyon sou peman reklamasyon an, sa ki ekonomize w tan ak lajan, pandan w ap amelyore efikasite
- Ou pa bezwen deklarasyon sou papye pou Eksplikasyon Avantaj yo (EOB)
EERS offers payees multiple ways to set up EFT and ERA in order to receive transactions from multiple payers. If a provider’s tax identification number (TIN) is active in multiple states, a single registration will auto-enroll the payee for multiple payers. You can also complete registration using a national provider identifier (NPI) for payment across multiple accounts.
ECHO Health processes and distributes claims payments to providers. To enroll in EERS, visit the Aetna Better Health ECHO portal. You can manage electronic funds transfer (EFT) and electronic remittance advice (ERA) enrollments with multiple payers on a single platform.
Sign up for EFT
To sign up for EFT, you’ll need to provide an ECHO payment draft number and payment amount for security reasons as part of the enrollment authentication. Find the ECHO draft number on all provider Explanation of Provider Payments (EPP), typically above your first claim on the EPP. Haven’t received a payment from ECHO before? You’ll receive a paper check with a draft number you can use to register after receiving your first payment.
Update your payment or ERA distribution preferences
You can update your preferences on the dedicated Aetna Better Health ECHO portal.
Use our portal to avoid fees
Fees apply when you choose to enroll in ECHO’s ACH all payer program. Be sure to use the Aetna Better Health ECHO portal for no-fee processing. You can confirm you’re on our portal when you see “Aetna Better Health” at the top left of the page.
Be aware — you may see a 48-hour delay between the time you receive a payment, and an ERA is available.
Helpful resources
ECHO resources
- ECHO companion document (PDF)
- ECHO enrollment form (PDF)
- ECHO payments innovation for health plans (PDF)
- ECHO portal guide (PDF)
- ECHO frequently asked questions from providers (PDF)
International Classification of Diseases (ICD-10) resources: