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Claims

You can file claims with us electronically or through the mail. We work to streamline the way we process claims. And improve payment turnaround time, so you can save time and effort.

 

Have questions?

You can download the provider manual (PDF).

 

Or contact us to learn more.

How do I file a claim?

You can file a claim:

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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 Texas claims using Office Ally is free of charge. The status of claims submitted online should be managed through your Office Ally Account.

 

If your electronic billing vendor is unable to convert to ID 38692, they can use the Aetna® commercial payer ID 60054.

 

You must have a Medicaid provider agreement with HHSC or its agent to participate in the Medicaid Program.

You can also mail hard copy claims or resubmissions to:

 

Aetna Better Health®
PO Box 60938 
Phoenix, AZ 85082 

 

Mark resubmitted claims clearly with “resubmission” to avoid denial as a duplicate.

 

CMS-1500 sample (PDF)

 

UB-04 sample (PDF)

How can I submit a claim reconsideration?

A claim reconsideration is a request that we previously received and processed as a clean claim.

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  • A claim form for each reconsideration
  • A copy of the remit/Explanation of Benefits (EOB) page for each resubmitted claim, with a brief note about each claim you’re resubmitting
  • Any information that the health plan previously requested

 

Be aware that we:

 

  • Process and decide claims within 30 days of receipt. This includes:

    • Completing the appeal and reprocessing.
    • Processing clean payments for professional and institutional claim submissions.
  • Process and decide claim reconsiderations within 120 days of the resolution date on the original (clean) claim’s EOB.
  • Identify a Coordination of Benefit (COB) resubmission as a claim previously denied for other insurance info, or originally paid as primary without coordination of benefits.
  • Process and decide COB claim reconsiderations within 95 days from the disposition date on the primary carrier’s EOB or response letter.

We can’t accept COB reconsiderations via electronic transmission.

 

You can file a claim reconsideration by mail:

 

Please mail your reconsideration form (PDF) and all supporting documentation to the following address: 

 

Aetna Better Health of Texas
PO Box 60938 
Phoenix, AZ 85082 

 

Learn more about claim appeals

 

More info

EFT/ERA Registration Services (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.

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EFT makes it possible for us to deposit electronic payments directly into your bank account. Some benefits of setting up an EFT include: 
 

  • Improved payment consistency 

  • Fast, accurate and secure transactions

 

ERA is an electronic file that contains claim payment and remittance info sent to your office. The benefits of an ERA include:
 

  • Reduced manual posting of claim payment info, which saves you time and money, while improving efficiency  

  • No need for paper Explanation of Benefits (EOB) statements

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 Aetna Better Health 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.

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