Claims

You’ll 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

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 New Jersey 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 to:

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

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

• CMS-1500 sample (PDF)
• UB-04 sample (PDF)

You can resubmit a claim through Availity or by mail. If you 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

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

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. 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, you must:

• Accept this payment as payment in full
• Not bill the beneficiary or anyone on the beneficiary’s behalf for any additional charges

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 these 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)

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 Aetna Better Health 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.