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.

Have questions?

You can download the provider manual (PDF). Or call Provider Services at
1-855-232-3596 (TTY: 711).

How do I file a claim?

First, you need to fill out a claim form. You must file claims within 180 days from the date you provided services, unless there’s a contractual exception. For inpatient claims, the date of service refers to the member’s discharge date. You have 180 days from the paid date to resubmit a revised version of a processed claim.

Online

Online

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, visit the WebConnect portal and follow the prompts to “Enroll New Customer.” Use 46320 for your provider ID.

By mail

You can also mail hard copy claims or resubmissions to:

Aetna Better Health® of New Jersey
Claims and Resubmissions
PO Box 982967
El Paso, TX 79998-2967

Use 46320 for your provider ID. Mark resubmitted claims clearly with “resubmission” to avoid denial as a duplicate.

How can I resubmit a claim?

You can resubmit a claim through WebConnect or by mail. If you resubmit through the WebConnect portal, you’ll need to mark your resubmission with a "7” in the indicator field.

If you choose to 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 we denied or incorrectly paid the claim
A brief note describing the requested correction
Any other required documents

How can I appeal a claim?

Both in-network and out-of-network providers have the right to appeal our claims determinations within 60 calendar days of receipt of the claim denial. To appeal, just use the Health Care Provider Application to Appeal a Claims Determination (PDF).

You can file an appeal:

By phone

Just call 1-855-232-3596 (TTY: 711).

By mail

You can send your appeal to:

Aetna Better Health of New Jersey
PO Box 81040
5801 Postal Road
Cleveland, OH  44181

Balance billing

Providers may not bill members for any services that are covered by NJ Medicaid and/or Aetna Better Health of New Jersey.

Any member copayments you must collect are included in the benefit listing. Please note that copayments are not considered balance billing.

Per your contract with us, when a provider receives a Medicaid/NJ FamilyCare, Fee-For-Service or managed care payment, the provider must accept this payment as payment in full and must not bill the beneficiary or anyone on the beneficiary’s behalf for any additional charges.

NOTE: Providers can make payment arrangements with a member for services that are not covered by NJ Medicaid and Aetna Better Health of New Jersey only when they notify the member in writing, in advance, of providing the service(s) and the member agrees.

Consequences you may face if you balance bill members

We want to make sure you are aware of these requirements because we value your partnership with us.

Federal and State laws are clear that providers are prohibited from balance billing Medicaid beneficiaries (42 USC 1395w-4(g)(3)(A), 42 USC 1395cc(a)(1)(A), 42 USC 1396a(n), 42 U.S.C. § 1396u-2(b)(6), 42 CFR 438.106, NJAC 11:24-9.1(d)9 and/or 15.2(b)7ii.

Before you decide to send accounts to any collection agency you may be using, it is critical that you NOT include Aetna Better Health of New Jersey member accounts.

Providers who balance bill Aetna Better Health of New Jersey members could face the following consequences:

Termination from the Aetna Better Health of New Jersey network
Referral to the NJ Medicaid Fraud Division to open an investigation into the provider's action
Referral to the Federal Department of Health & Human Services, U.S. Office of Inspector General (HHS-OIG)

Helpful resources

Check out these resources to learn more about claims submissions and International Classification of Diseases, Tenth Revision (ICD 10).

Claims submissions:

Balance Billing Fact Sheet (PDF)

Provider quick reference guide (PDF)

Tips for risk adjustment coding and medical documentation (PDF)

ICD 10:

Centers for Medicare and Medicaid Services

American Academy of Professional Coders

American Health Information Management Association documentation tips (PDF)