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Claims

You can file claims with us 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. 

 

Questions?

You can check your provider manual. Or contact us.

Fee schedules and billing codes

 

You can find the billing codes you need for specific services in the fee schedules.

 

Fee schedule

You’ll need to fill out a claim form.
 

You must file new claims within 365 days from the date you provided services, unless there’s a contractual exception. For hospital inpatient claims, the date of service refers to the date that the member was discharged.

Some timeframes to note:

  • Medicaid: You have 180 days from the paid date to resubmit a revised version of a processed claim.  

  • Medicare-Medicaid (Aetna Better Health® Premier Plan): You have one year from the date of service or discharge 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 Michigan 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:
 

Medicaid:

Aetna Better Health® of Michigan

PO Box 982863

El Paso, TX 79998-2963
 

Medicare-Medicaid (Aetna Better Health Premier Plan):

Aetna Better Health of Michigan

PO Box 982963 

El Paso, TX 79998-2963

 

Mark resubmitted claims clearly with “resubmission” to avoid denial as a duplicate.

You can submit a claim reconsideration through Availity or by mail. If you submit by mail, you’ll need to include these documents:

 

  • Claim reconsideration and dispute form
  • 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 we denied or incorrectly paid the claim
  • A brief note describing the requested correction
  • Any other required documents

Mark submission clearly with “reconsideration” or “corrected claim.”

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 SoonerSelect 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.

Helpful resources


ECHO resources


International Classification of Diseases (ICD-10) resources:

 

Also of interest: