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Fee schedules and billing codes
You can find the billing codes you need for specific services in the fee schedules.
Doula provider billing guide (PDF)
Provider reimbursement fee schedule
You’ll need to fill out a claim form.
You must file claims within 180 days of the date you provided services, unless there’s a contractual exception. For inpatient claims, the date of service refers to the member’s discharge date. You have 180 days from the paid date to resubmit a revised version of a processed claim.
Online
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 Florida claims using Office Ally is free of charge. The status of claims submitted online should be managed through your Office Ally Account.
By mail
You can also mail hard copy claims or resubmissions to:
Aetna Better Health of Florida
PO Box 982960
El Paso, TX 79998-2960
Mark resubmitted claims clearly with “resubmission” to avoid denial as a duplicate.
You can resubmit a claim through Availity or by mail. If you resubmit by mail, you’ll need to include these documents:
- Claim adjustment request/claim reconsideration form (PDF)
- An updated copy of the claim — all lines must be rebilled
- A copy of the original claim (reprint or copy is acceptable)
- A copy of the remittance advice on which we denied or incorrectly paid the claim
- A brief note describing the requested correction
- Any other required documents
To learn more about claim appeals, just visit our complaints and appeals page.
A claim reconsideration is a request that we previously received and processed as a clean claim.
When you send a reconsideration, be sure to include:
- A claim adjustment request/claim reconsideration form (PDF) 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:
Mail your claim adjustment request/claim reconsideration form and all supporting documents to:
Aetna Better Health of Florida
PO Box 982960
El Paso, TX 79998-2960
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.
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 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