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For Providers

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Welcome, providers!

We see you as our ally in providing high-quality health care services to our members in the Aetna Better Health of Ohio, a MyCare Ohio plan. We are a Medicare-Medicaid plan for dual-eligible members. As you strive to deliver the best care possible and to better understand Aetna Better Health, we hope you’ll take advantage of all the resources we have to offer.

We provide our members with access to important health care services and programs. We designed this to be convenient for our members and providers.

Members must live in one of these counties:

Northwest Region Counties (Metro Toledo area): Fulton, Lucas, Ottawa or Wood
Southwest Region Counties (Metro Cincinnati area): Butler, Clermont, Clinton, Hamilton or Warren
Central Region Counties (Metro Columbus area): Delaware, Franklin, Madison, Pickaway or Union

Because Aetna Better Health of Ohio manages both Medicare and Medicaid coverage, our members only have to work with us. We take care of it all, including dental, vision and mental health benefits, and more. It also simplifies your office processes.

Plus, we work to make it easy for you to care for our members and guide them down the path to better health.

Useful Links and Resources

Update Your Practice Information

Update your office hours.

Short Provider Survey & Cultural Competency Attestation

Click here to take a short survey and help us keep our directory up to date.

Electronic Visit Verification (EVV)

Click here to learn more about EVV or register for a live webinar.

First-Tier, Downstream and Related Entities (FDR) Links

List of Ohio's FDR entities

Learn how to complete FDR Training.

Home and Community-Based Services (Waiver)

Click here for an overview of Aetna Better Health of Ohio's Home and Community-Based Services Waiver Program.

Optimization of Pregnancy Outcomes

Access FAQ's to help keep women of reproductive age healthy.
Obtain additional information about the Progesterone Project here.
Providers are recommended to complete the Web-Based Pregnancy Risk Assessment Form to connect pregnant women to needed services.

Centralized Credentialing

Ohio provider information updates must be completed through the Ohio Department of Medicaid (ODM) Provider Network Management (PNM). Providers must update their information through the PNM, which will then update their information with Aetna Better Health of Ohio. With the exception of select provider types (e.g. Comprehensive Post-Acute Network [CPAN], Ohio Aging Services Network [OASN], and Area Agencies on Aging [AAA]), all providers will need to use the centralized PNM module. Updating through PNM will ensure claim payments, provider directories, and network adequacy measurements are not negatively impacted. Further information can be found at https://managedcare.medicaid.ohio.gov/managed-care/centralized-credentialing.

Remittance Advices

Remittance Advices (RA) are located on Aetna Better Health's secure web portal. It is the provider's responsibility to download and save or print and save these payment registers for payment reconciliation and required documentation retention. We will no longer reprint RAs for providers or vendors contracted with providers. Providers must log in to the secured portal and obtain the RA when one is posted, and they must make arrangements to supply these documents, or give access to these documents, to any contractor/vendors working on their behalf.

Financial Liability for Payment of Services

Balance billing enrollees is prohibited under the MyCare Ohio plan. In no event should a provider bill an enrollee (or a person acting on behalf of an enrollee) for payment of fees that are the legal obligation of Aetna Better Health of Ohio. This includes any coinsurance, deductibles, financial penalties, or any other amount in full or in part.

Providers must make certain that they are agreeing not to bill an enrollee for medically necessary services covered under the plan and to always notify enrollees prior to rendering services. Providers must also make certain that they are agreeing to clearly advise an enrollee, prior to furnishing a non-covered service, of the enrollee's responsibility to pay the full cost of the services.

Provider Terminations

In order to meet contractual obligations and state and federal regulations, providers who are in good standing, are required to report any terminations or additions to their agreement at least sixty (60) days prior to the change for Aetna Better Health of Ohio to comply with CMS requirements. Providers are required to continue providing services to enrollees throughout the termination period. The Centers of Medicare and Medicaid (CMS) require that Aetna Better Health of Ohio make a good faith effort to provide written notice of termination of a network provider at least sixty (60) days before the termination effective date to all enrollees who are patients seen on a regular basis by the provider whose Provider Agreement is terminating. However, please note that all enrollees who are patients of that PCP must be notified when a provider termination occurs.