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Do your patients currently have health insurance through Medicaid or the Maryland Children's Health Program (MCHP)?
- Ask your patients to make sure their contact information is up to date with Maryland Health Connection.
- Encourage them to be on the lookout for notices, as they will be contacted by mail or through their online account when it’s their turn to renew.
- And please stress the importance of completing renewals on time. Participants can log in to their account at MarylandHealthConnection.gov/Checkin or call 855-642-8572 to get started.
Please click here for more information.
Notice of Aetna Better Health of Maryland Medicaid Precertification Optimization PA Requirement.
Dear Valued Provider,
In a periodic review of our Prior Authorization code listing, we are adding the attached list of codes which will require prior authorization. If you have questions, contact your health plan representative. Effective September 1, 2023 Aetna Better Health of Maryland will require prior authorization for the set of codes listed below for participating providers. This is part of a larger optimization initiative intended to ensure the safety, medical necessity ,and appropriateness of request procedures.
Notice of Aetna Better Health of Maryland Medicaid Precertification Optimization PA requirement.
Effective September 1, 2023 Aetna Better Health of Maryland will 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.
Notice of Non-Covered Monovalent COVID19 Code Updates
Dear Valued Provider,
In a periodic review of our Prior Authorization code listing and coverage, we are updating
the attached list of codes to non-covered. If you have questions, contact your health plan
representative. Aetna Better Health of Maryland will deny claims received on or after 4/18/2023 for the set of codes listed below for participating providers. This is part of a larger optimization initiative intended to ensure the safety, medical necessity, and appropriateness of requested procedures.
Aetna Better Health in collaboration with Change Healthcare has enabled a solution designed to alert providers when diagnosis codes are potentially missing from a claim. This is accomplished by sending the biller the standard EDI remittance advice (277CA) associated with claim rejections that are integrated into the claim submission process. The automated rejection messages appear in the billing solution alert queue and are triggered on claims that may be incomplete or inaccurate for patients with historic claims data, such as evidence of an established diagnosis of a chronic condition that is not present on the current claim.
For questions about a claim status message or general program questions, please call Change Healthcare Customer Service at 1-844-592-7009, option 3 or you can visit their website at Change Healthcare Provider Enrollment.
Effective August 8th, 2022, Aetna Better Health of Maryland will 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. Please see attached notice for listing of procedure codes/descriptions no longer requiring prior authorization.
Please see attached bulletin from The Maryland Department of Health in reference to the global change in epidemiology of Monkeypox to ensure appropriate screening, infection prevention and notification processes are in place.
Aetna Better Health of Maryland will no longer accept provider mail that is directed to our Linthicum, MD office. Please see attached bulletin for details regarding resubmissions, reconsiderations, disputes, and appeals and grievances.
In our effort to ease the administrative burden and support ongoing quality care to our members, Aetna Better Health of Maryland is making several updates related to our utilization management processes for our Aetna Better Health of Maryland members. These changes are effective immediately and will remain in effect through the end of the Maryland State of emergency.
New P.O. Box Address and Vendor for Paper Claim and Claim Correspondence - Effective 3/15/2022
Aetna will be replacing the current vendor, Change Healthcare (CHC), with Conduent for services related to the receipt and imaging of all paper claim and claim correspondence. The change in vendor requires a change in the P.O. Box number and physical location to which any Aetna Medicaid paper claim and correspondence are currently sent, specifically from P.O. Box #61538 in Phoenix, AZ to P.O. Box #982968 in El Paso, TX.
We are eager to announce that we are live with Availity provider portal! We are excited about the increased in online interactions available to support you as you provide services to our members.
Some of the benefits of the increased functionality provided by Availity include:
• EFT registration
• Claims look up
• Online claim submission
• Prior authorization submission and look up
• Grievance and appeals submission
Please be sure to contact our Provider Relations Department to ensure we have your most recent e-mail address. Future communication and updates regarding Availity will be sent via e-mail.
Effective July 1, 2021
Governor Larry Hogan announced the end of the COVID-19 state of emergency in the State of Maryland. This will end emergency mandates on July 1, 2021. To that end, we will return to the timeframe for receiving clinical information from providers. As a reminder, clinical information is expected within 24 hours or the next business day as outlined in our provider manual.
Ensuring that we have current information about our network providers’ practices is key to our members locating the right practitioner of care as quickly as possible. Please see the link to the notice for validating and updating necessary practice information below. If you have any questions, please contact us at 1-866-827-2710 (TTY: 711) and select option 2.
Provider data validation (PDF)
The following notice from the Maryland Department of Health and Mental Hygiene refers to two billing issues of concern to the department: balance billing and billing of participants for covered services.
Member billing notice (PDF)
Health education tailored to our members’ needs
Aetna Better Health of Maryland provides one-on-one health education for our members who need it. If you believe a member needs health education tailored to their condition, please contact us at 1-866-827-2710 (TTY: 711) and ask for the Special Needs Coordinator.
Aetna Better Health of Maryland recently changed authorization requirements for various HCPCS and/or CPT codes. These authorization requirements change how claims are processed. There are 31 codes that now require prior authorization. These codes will be reviewed for medical necessity. There are 68 codes that no longer require prior authorization. Please view the listing of codes that no longer require prior authorization.
Quality Management News
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