Billing for COVID-19 vaccination and Monoclonal Antibody infusion treatment

CMS News:CMS Takes Action to Protect Integrity of COVID-19 Testing

Negative Balance Report Generator_ Provider Notice 09 22 2020

HFS Notice – HCBS Provider Bulletin Communication for Atypical Billers


COVID-19 Updated May 31, 2020: Prior Authorization/Pre-Certification/Admissions Protocol

Prior Authorization Code Changes 05 11 2020 Effective 07 01 2020

COVID-19 Update Effective May 7, 2020: Prior Authorization/Pre-Certification/Admissions Protocol

COVID-19 Updated 04/14/2020: Prior Authorization/Pre-Certification/Admissions Protocol

Clinical Payment, Coding and Policy Review

Sterilization Code Update

Grievances Appeals Address Change

CARC-RARC Codes for Upheld Disputes Reminder

Eviti Provider Notice Letter 2-11-2020

Aetna Better Health of IL - HFS Reference Number Notification 02-10-2020

30 Day Readmission Process Reminder

OTP Provider Notice and FAQ 02-06-2020

Proposed Claim Edit IL - Regarding Status B Codes

Surgical And Inpatient Behavioral Health Admission Letter

2020 HFS Notification for Patient Credit File

Provider Notification for Billers Utilizing Code J3145

DME Provider Notification 12/19/2019

Payment Integrity Notice for All Aetna Better Health Providers 12/19/2019

PDGM Reminder Communication 12-13-2019

PDPM Provider Communication

Provider Refund Check Address Change for Aetna Better Health of IL

HFS Hospice Billing Changes

Change in Prior Authorization Requirements S2900

340B Drug Recoupment

Pharmacy Electronic Prior Authorization

Equian DRG Validation

Home Health Claims Update

Ordering, Referring, Prescribing (ORP) - National Provider Identifier (NPI) Requirements

Reminder of our Provider Disputes and Appeal Process

Change In Incontinence Authorization Supplies Prior Authorization Requirements

Change in Prior Authorization Requirements CMHC – Rule 132 Codes

Secondary Medicaid Payment Responsibility in Coordination of Benefits (COB)

Change In Prior Authorization Requirements & Modifier Processing

Change In Prior Authorization Requirements for Home Health Providers

Medicare-Medicaid Alignment Initiative Simplified Credentialing

What do the new Medicare ID cards mean for Provider?

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:

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.

Updating the Provider Directory Survey

As part of our ongoing effort to report accurate and complete information in our directory, your office was identified as missing hours of operation information. This information is required by CMS and the Illinois Department of Healthcare and Family Services for each provider in our directory.  We are requesting that you take a moment to provide this information for your location(s). 

Fill out the survey  for your locations, indicating your office details and the hours of operation.

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.

Any additional information related to the above notice can be directed to the provider services at Aetna Better Health.