Subrogation For Aetna In California
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FAQ
Use the CPT Code 99404 in order to indicate the sessions is billed under EAP.
You can submit claims online or resubmissions through ConnectCenter.
EAP claims should be submitted through Provider Express or on a CMS-1500 claim form using the standard "HJ" modifer in section 24D.
Aetna Signature Administrators® is the brand name for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).
You can submit a claim online through the member website at myaetnasupplemental. Or you can download a paper claim form or request one be sent to you by our customer service and mail it to: Aetna Voluntary Plans, PO Box 14079, Lexington, KY 40512-4079.
The Aetna case started in 2012 when the carrier filed suit (1-12-CV-217943) against Northern California surgery provider Bay Area Surgical Management LLC (BASM) for allegedly conducting a widespread conspiracy to defraud the insurer via the use of out-of-network benefits.
Timeframes for reconsiderations and appeals Dispute levelDoctor / provider submission timeline Reconsideration Within 180 calendar days of the initial claim decision. Appeals Within 60 calendar days of the previous decision.
What is aetna reconsideration form? The Aetna reconsideration form is a document that allows individuals or healthcare providers to request a review or reconsideration of a denied claim or coverage determination by Aetna, a health insurance company.
Filing an appeal You can file an appeal within 180 days of receiving a Notice of Action. The Appeals and Grievance Manager will send an acknowledgment letter within five business days.
