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Understanding electronic claims submission

23.03.892.1 B (5/13)

•Enter the member ID number exactly as it appears on the ID card. Do not include any dashes, suffixes or spaces.

•Review reports promptly to identify any items that require attention.

•Correct rejected claims and resubmit electronically.

•All providers, both participating and nonparticipating, can submit claims electronically regardless of patient’s benefits plan.

•Avoid the additional cost of submitting duplicate claims by using the Claim Status Inquiry to check the status of claims prior to resubmitting.

•Attachments aren’t necessary. We’ll contact you if we need additional documentation.

•For questions on how to submit electronic claims to third-party administrators, such as an individual practice association, contact the third-party administrator.

If necessary, use the following claims billing addresses

If your practice management system requires you to enter a billing address, use the address listed below for the state in which you practice:

State AL, AK, AR, AZ, CA, FL, GA, HI, ID, LA, MS, NC, NM, NV, OR, SC, UT, TN, WA

Address Aetna PO Box 14079 Lexington, KY 40512-4079

State CO, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD, ME, MI, MN, MO, MT, NE, ND, NH, NJ, NY, OH, OK, PA, RI, SD, TX, VA, VT, WI, WV, WY

Address Aetna PO Box 981106 El Paso, TX 79998-1106

Aetna Student HealthSM PO Box 15708 Boston, MA 02215-0014 Payer ID — 60054

Affordable HealthChoices from Aetna® SRC, an Aetna company PO Box 14079 Lexington, KY 40512-4079 Payer ID — 57604

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies (Aetna).

www.aetna.com

©2013 Aetna Inc. 23.03.892.1 B (5/13)

Requirements to submit Coordination of Benefits (COB) claims electronically

To submit COB claims electronically, your practice management system and your vendor must be able to:

• Create or forward claims in the full HIPAA standard format (837) or in a format that contains equivalent information and includes necessary COB fields.

•Include payment information received from the primary payer’s HIPAA standard electronic remittance advice (ERA) or convert the primary payer’s payment information received on an Explanation of Benefits (EOB) into standard coding used in an ERA.

To learn more about submitting COB claims electronically, go to www.aetna.com/provider/ecob.

Where to turn for help

Depending on your situation, you have a variety of resources to help you find the answers you’re looking for:

• If your claim rejects at the vendor level, contact your vendor.

• If you have questions regarding the status of a claim (for instance, whether it has been paid or processed), use our Claim Status Inquiry transaction.

•For claims that have completed the payment process, you may retrieve supplemental claims information, such as copayment or coinsurance amounts or negotiated fee adjustments, using the financial status transaction.*

Need more help with electronic claims submissions? Use the Contact Us link on our website at www.aetna.com. Or, call your vendor’s customer service help line.

*Availability varies by vendor.