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All home- and community-based services (HCBS) waiver providers are required to bill Aetna Better Health® of Illinois on a medical claim form.
HCBS and supportive living programs (SLPs) need to bill Aetna Better Health via our online portal or on the Health Care Finance Administration (HCFA) 1500 form. We have a variety of resources available to providers to help you bill correctly.
Please visit our “Waiver resources” page for more information. Below, please find a chart outlining the services, as well as corresponding codes and increments that should be used when billing for services provided to an Aetna Better Health member.
Note:
Rates are subject to change. All rates reflect the current Medicaid fee schedule for the services listed.
Joe Member goes to adult day service for 3 hours every weekday. Sunrise Day Center needs to submit a claim to Aetna Better Health with the code S5100. Here’s how to calculate the bill:
- In the previous month, there were 22 days that Joe went to the center. The total number of hours would be calculated this way: 22 x 3 = 66 hours.
- However, Aetna Better Health units are in 15-minute increments. Since there are four 15-minute increments in an hour, that means the total hours would be multiplied by 4: 66 hours x 4 = 264 units. This is how many units Joe used in 1 month.
- To find the total cost, multiply the number of units by the rate: 264 x $3.58 = $945.12.
Supportive Living Program rates
SLP rates are based upon the geographic area. Aetna Better Health does not pay for room and board, but we do reimburse for services provided in the SLP. Rates for our service area are included in the link below.
Rates for our service area are included below:
- Cook, DuPage, Lake and Kane Counties: $74.66 per day
- Will and Kankakee Counties: $71.40 per day