Notices

Dear Provider,

Effective June 1, 2022, Aetna Better Health Premier Plan MMAI w ill no longer require prior authorization for the set of codes listed below. This is part of a larger optimization initiative intended to improve operational efficiency and reduce unnecessary provider administration activity.

As always, do not hesitate to contact your Aetna Better Health Premier Plan MMAI Provider Relations Representative with any questions or comments.

Thank you for your valued partnership in caring for our Aetna Better Health Members.

Sincerely,

Provider Services

Aetna Better Health Premier Plan MMAI

Phone: 866-600-2139

Nursing Facility Claim Submission Update

Custodial Nursing Facility

Aetna Better Health of Illinois has made changes to the prior authorization for the payment of custodial nursing facility claim. Click here for more information.

Fee Schedule Updates 

The following fee schedule updates have been processed at Aetna Better Health:

• Community Mental Health Services Fee Schedule effective 8/1/18
• Nursing Facilities Fee Schedule effective 10/1/18

Please utilize the Propat Tool located on the Aetna Better Health Secure Web Portal to review codes and check for prior authorization requirements.

IL State IMPACT Provider System Notice 

Prescriptions written by prescribers who have not registered with the Illinois state IMPACT system and who have not met the business rules below will not process at the pharmacy and will not be covered by Aetna Better Health of Illinois. For more details view the full statement.

Medicare Outpatient Observation Notice Required Starting March 8

Developed by the Centers for Medicare & Medicaid (CMS), the Medicare Outpatient Observation Notice (MOON) serves as the standardized notice used by hospitals and critical access hospitals (CAH) to notify Medicare patients who receive more than 24 hours of observation services that their hospital stay is outpatient, not inpatient. You must provide the MOON to these patients no later than 36 hours after services begin.

How to comply

• Begin issuing the MOON no later than March 8, 2017. Provider compliance with this notification requirement is mandatory.
• Deliver a hard copy of the MOON to beneficiaries and enrollees. 
• Obtain the signature of the individual on the MOON or an individual acting on behalf of the patient. 
• Retain a copy of the signed MOON. You may store the MOON electronically if you keep electronic medical records.
• Give the beneficiary a paper copy of the signed MOON, regardless of whether a paper or electronic version is issued, and whether the MOON is signed digitally or manually.   

You may give the MOON by telephone in cases where the beneficiary has a representative who isn't physically present, as long as a hard copy is delivered to the representative. 

The standard language for the MOON notice and instructions can be accessed on the CMS website at:  https://www.cms.gov/Medicare/Medicare-General-Information/BNI/index.html

Provider Directory Database Update - 5/18/2017 

Aetna Better Health of Illinois is dedicated to providing our members with accurate and up to date information about the providers we list in our online directory database. This quick survey will allow us to ensure that our directory information is current so that our members are able to get the care that they are seeking in a timely manner. We appreciate you taking the time to check our provider directory, and provide any updates or changes to the information.  Please click the following link for the survey.

Long Term Care Facility Billing Charges 

Aetna Better Health is in the process of updating our payment systems to be compliant with the 12-1-2016 Long Term Care Facility Billing Changes set forth by HFS. Providers should continue to bill claims with the appropriate billing instructions consistent with the date of service.  Please click here for more information.

Weekend Utilization Management Policy

We are writing to inform you of a policy change related to our "Weekend Utilization Management Policy" that was implemented in July 2016. Aetna Better Health of Illinois has heard your feedback and we are adjusting the policy based on your suggestions. Click here for more information on this policy.

General Acute Care and Children’s Billing Guidelines - 11/10/2016

The Illinois Department of Healthcare and Family Services (HFS) requires Managed Care Organizations (MCO) to meet very specific claim data submission standards requiring particular and exact data elements on claims submitted from Hospitals. To facilitate the appropriate application of these rules, Managed Care Organizations are collectively relaying the enclosed information in this Provider Memorandum in an effort to reiterate and provide transparency on hospital billing guidelines for services rendered in a Children’s and General Acute Care Institutional setting.  Please click here here to read the official memorandum. Click here for the General Acute Care and Children’s Billing Guidelines.

Medicare Prescriber Enrollment

Beginning 2/1/2017, Aetna Better Health will require prescribing providers to be either enrolled in Medicare fee-for-service or have a valid opt-out affidavit on file effective Feb 1st, 2017.  Starting on February 1st, 2017, MMAI members will obtain a provisional supply when filling prescriptions written by prescribers who do not meet the above requirement.

For additional information visit the CMS provider and supplier enrollment page.