Get Aetna Better Health Of Illinois Instructions For Electronic ...

Filling out the AETNA Better Health of Illinois Instructions for Electronic Remittance Advice (ERA) can initially seem complex, but this guide will provide you with comprehensive and user-friendly steps to complete the form efficiently. By following these clear instructions, you will ensure accurate processing of your enrollment, change, or cancellation requests.

Follow the steps to complete the form correctly.

1. Begin by clicking the ‘Get Form’ button to access the Electronic Remittance Advice Authorization Agreement Form and open it for edits.
2. Carefully review the provider information section. Fill in the provider's legal name, doing business as name, address, city, state, and zip code. Ensure all information is clear and legible.
3. In the provider identifiers information section, input the Federal Tax Identification Number (TIN) or Employer Identification Number (EIN) along with the National Provider Identifier (NPI). Verify that the NPI is included to avoid return of the form.
4. Complete the provider contact information section, providing a contact person's name, telephone number, email address, and fax number. This information is vital for any future inquiries related to the ERA.
5. In the electronic remittance advice information section, select your preference for aggregation of remittance data. Define whether you prefer the Provider TIN or NPI for account number linkage.
6. Fill out the electronic remittance advice clearinghouse information. This includes providing the name of your clearinghouse and the relevant contact details.
7. Identify your reason for submission in the submission information section by selecting from options like new enrollment, change enrollment, or cancel enrollment.
8. Ensure that the form is signed by the appropriate person. Include the written signature, printed name, and title of this individual.
9. Before submitting the form, double-check that all required sections are completed, and all information is clearly typed or printed. Incomplete or illegible forms will be returned.
10. Upon completion, you can submit your form via fax to Aetna Better Health of Illinois Provider Services at 860-754-0435 or via email to AetnaBetterHealthILProviderServices@aetna.com. Remember to send only one form per fax or email.

Complete your electronic remittance advice enrollment online today for a seamless healthcare experience.