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Claims

You can file claims with Aetna Assure Premier Plus (HMO D-SNP) online or through the mail. We do our best to streamline processing. And improve payment turnaround time so you can save time and effort.

You can submit a claim:

En línea

En línea

You can submit claims or resubmissions online through WebConnect. This is our provider claims submission portal via Change Healthcare (formerly known as Emdeon). To register, just choose “WebConnect site” below and follow the prompts to “Enroll New Customer.”

 

You can also mail hard copy claims or resubmissions to:

Aetna Assure Premier Plus (HMO D-SNP)  

Claims and Resubmissions 
PO Box 61925

Phoenix, AZ 85082-1925 

ConnectCenter

ConnectCenter

Within the next two months, ConnectCenter will replace Emdeon Office, giving you a more reliable and more complete way to submit claims. You will be able to use your ConnectCenter and Emdeon Office accounts at the same time until 4/30/2021. After that date, most of your Emdeon Office account will be deactivated. However, we will provide continued access to old claims by allowing you to log in directly to the Reporting & Analytics feature, within Emdeon Office.

In order to ensure that you have as much time as possible to transition to ConnectCenter, we highly recommend that you start using it immediately. Change Healthcare has produced and made available the Getting Started with the Sign-Up process guide (PDF) guide to assist in general navigation and registration with ConnectCenter powered by Change Healthcare office.

Please review the guides below for verifying member eligibility and claim submissions.

 

Getting Started with Eligibility in Connect Center (PDF)

Getting Started with Provider Management in Connect Center (PDF)

Getting Started with Claims in ConnectCenter (PDF)

Uploading a Claim in ConnectCenter (PDF)

Keying Professional Claims in ConnectCenter (PDF)

Keying Institutional Claims in ConnectCenter (PDF)

Obtaining a Claim status in ConnectCenter (PDF)

 

How do I file a claim?

How do I file a claim?

Aetna Assure Premier Plus (HMO D-SNP) encourages providers to electronically submit claims, through Change Healthcare. You will need to fill out one of the claim forms. You will want to use ID # 46320 as the Submitter (Payer) ID on both forms. 

 

You’ll want to use this Submitter ID number when you submit claims: Payer ID# 46320 for both CMS-1500 (PDF) and UB-04 (PDF) forms.

 

Check the policies and procedures in the provider manual (PDF) if you’re an out-of-network provider seeking payment of claims for services we cover for providers who are non-participating, such as:

 

  • The plan covers emergency care or urgently needed services from an out-of-network provider

  • If a member needs to seek medical care and there are no providers in the network that can provide care, members can see a non-participating provider with a prior authorization

  • The plan covers kidney dialysis services that are at a Medicare Certified dialysis facility when the member is temporarily outside the plan’s service area with a prior authorization  

Electronic funds transfer (EFT)

EFT makes it possible for us to deposit electronic payments directly into your bank account. You can get an EFT form (PDF) here. Some benefits of setting up an EFT include:

 

  • Improved payment consistency

  • Fast, accurate and secure transactions

  • Payments sent directly into your bank account

Electronic remittance advice (ERA)

ERA refers to an electronic file that contains claim payment and remittance information sent to your office. Sometimes, we’ll refer to ERA by its HIPAA transaction number: 835. You can find an ERA form (PDF) here. The benefits of an ERA include:

 

  • Reduced manual posting of claim payment information, which saves you time and money, allowing you to more efficiently manage your resources

  • Elimination of the need for paper Explanation of Benefits (EOB) statements

How can I resubmit a claim?

Claim resubmissions (corrected claims)

 

With a claim resubmission, you’ve corrected the claim itself and chosen “Corrected” as the Bill Type code. You will resubmit the claim by mail:

 

Write “RESUBMISSION” across the top of your paper claim resubmission.

Then, mail it to:

Aetna Assure Premier Plus (HMO D‑SNP)

PO Box 61925, Phoenix, AZ 85082-1925

 

Claim reconsiderations 

 

With a claim reconsideration, you’re not correcting the claim in any way. But you disagree with the original claim outcome and want to challenge the payment or denial of a claim.  

 

 

  • Claim Reconsiderations for (PAR) providers (Dispute) – a claim for a PAR provider in which the provider is not correcting the claim in anyway, but disagrees with the original claim outcome and wishes to challenge the payment or denial of a claim. This requires the provider to fill out the PAR Provider Dispute Form (PDF)

 

  • Alternatively, a PAR provider can also submit a Reconsideration via the Provider Portal for better convenience. Once the provider has access, instructions for reconsideration submission through the portal can be found here (PDF).

 

  • Claim Reconsiderations for non-PAR providers (Appeal) - a claim for a non-contracted provider in which the provider is not correcting the claim in anyway, but disagrees with the original claim outcome and wishes to challenge the payment or denial of a claim. This requires the provider to fill out the non-PAR Provider Appeal Form (PDF).

 

Questions about claims or electronic billing?

You can call Provider Services at 
1-844-362-0934 (TTY: 711).