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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.

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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. 

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

Por correo postal

Por correo postal

You can also mail hard copy claims or resubmissions to:
 

Aetna Better Health® of New Jersey 
Claims and Resubmissions 
PO Box 61925 
Phoenix, AZ 85082-1925
 

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:

Por teléfono

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

Por correo postal

You can send your appeal to:

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

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 here or on our Provider Portal. Some of the benefits of setting up an EFT include:

 

  • Improved payment consistency

  • Fast, accurate and secure transactions

 

Once you complete the EFT form, you can submit it by:

 

  • Faxing us at 1-844-362-1710 

Electronic remittance advice (ERA)

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 

 

Once you complete the ERA form, you can submit it by:

 

  • Faxing us at 1-844-219-0223

Helpful resources 

 

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

 

Claims submissions:

 

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)