Claims
You can file claims with Aetna Better Health® of Kentucky electronically or through the mail. We work to streamline the way we process claims. And improve payment turnaround time, so you can save time and effort.
File a claim
-
First, you need to fill out a claim form. You must file claims within 365 days from the date services were performed, unless there’s a contractual exception. For inpatient claims, the date of service refers to the member’s discharge date. You have 730 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 Kentucky 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 Kentucky
P.O. Box 982969
El Paso, TX 79998-2969
Use 128KY for your payer ID. Resubmitted claims should have “resubmission” marked clearly on the claim form to avoid being denied as a duplicate.
For claims including Coordination of Benefits, the Commercial Insurance Coverage Provider Attestation may be used in lieu of the Explanation of Benefits (EOB).
-
You can resubmit a claim through Availity or by mail. If you resubmit by mail, you’ll need to include these documents:
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 the claim was denied or incorrectly paid
A brief note describing the requested correction
Any additional required documentation
-
TRP – summary of provider education and reimbursement guidelines (PDF)
Psychological and neurological testing (PDF)
Vaccines For Children program (PDF)
E/M service performed during a global surgery procedure (PDF)
Multiple gestation/duplicate claim logic for drugs (PDF)
Reimbursement Policy Statement - Definitive drug testing (PDF)
Reimbursement Policy Statement - Comprehensive community support services (PDF)
Reimbursement Policy Statement - Peer support (PDF)
Reimbursement Policy Statement - Psychoeducation (PDF)
Clinical payment coding and policy changes - Infliximab (PDF)
Proprietary Evaluation and Management (E&M) program claim and code review (PDF)
Clinical policy updates: genetic testing (PDF)
TRP and CCSS services billed on the same date of service (PDF)
ABHKY updated claim policy edits - audiology, vision and physician (PDF)
Updated claim policy edits - NCD labs and precertification optimization (PDF)
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.
Questions?
You can download the provider manual (PDF). Or call Provider Relations at 1-855-300-5528 (TTY: 711).