Billing Home Care and Social Day Care providers
Home Care and Social Day Care providers in the Aetna Better Health of New York network will be required to submit all claims on UB 04. If a participating provider does not submit appropriately, claims may be delayed or denied.
Effective June 1, 2015 - Home Care providers
Effective July 1, 2015 - Social Day Care
A reference guide to billing has been created to assist Home Care and Social day providers that will be impacted by the change on how to bill on UB-04. This will be the claim form that will be used for these provider types. These provider types are not use the UB-92 or CMS-1500 forms.
Reminder- Timely Filing of Claim Submissions
In accordance with contractual obligations, claims for services provided to an enrollee must be received in a timely manner. Our timely filing limitations are as follows:
New Claim -MLTC claims must be submitted within 120 days from the date of service. Aetna Better Health will consider a claim for resubmission only if it is re-billed in its entirety.
Claim Resubmission- MLTC Providers have 180 days from the date of remittance to resubmit a claim. Providers must include the nature of the request, member’s name, date of birth, member identification number, service/admission date, location of treatment, service or procedure, documentation supporting request, copy of claim, and a copy of remittance advice on which the claim was denied or incorrectly paid. Providers must additionally stamp or write one of the following labels on the claim if resubmitting a paper claim Resubmission Rebill Corrected bill Corrected Rebilling
For electronic resubmissions, providers must submit a frequency code of 7 or 8. Any claims with a frequency code of 5 will not be paid. Providers can resubmit hard copy claims directly to Aetna Better Health via mail to the following address:
Aetna Better Health of New York
PO Box 982972
El Paso, TX 79998-2972
Failure to submit claims within the prescribed time period may result in payment delay and/or denial.
Non-network providers rendering prior authorized services follow the same timely filing guidelines as original Medicaid guidelines.
For assistance, please call Provider Relations at 1-855-456-9126.