Provider Education Resources
Below you will find resources to help you learn more about important processes, procedures and educational tools that will help to make your role easier!
Aetna Better Health Contact Information
Billing and Claim Information
Billing and Claims Quick Reference Guide
Electronic Fund Transfer (EFT) - Click here then click on the Electronic Fund Transfer (EFT) tab for the EFT form and general information.”
Electronic Remittance Advice (ERA) - Click here then click the Electronic Remittance Advice (ERA) tab for the ERA form and general information.
Office Ally Clearinghouse - Click here then click the Feb 2017 Claims, Billing, and Reimbursement Notice.
Provider Timely Submission Guide - Click here then click the March 2016 Claims, Billing, and Reimbursement Notice.
PROMISe Billing Requirements
FAQs About Provider PROMISe ID Enrollment Revalidation ORP - Click here then click the October 2017 FAQs Notice.
Check PROMISe Enrollment Status - Click here then click the May 2019 Claims, Billing and Reimbursement Notice.
837 I/P Taxonomy Requirement - Click here then click the February 2019 Claims, Billing and Reimbursement Notice.
PROMISe Billing Requirement Reminder - Click here then click the July 2019 Claims, Billing and Reimbursement Notice.
PROMISe ID Enrollment Required at All Service Locations - Click here then click the February 2019 Claims, Billing and Reimbursement Notice.
Required Enrollment of Ordering Referring Prescribing Providers (CHIP) - Click here then click the August 2017 Claims, Billing and Reimbursement Notice.
Required Enrollment of Ordering Referring Prescribing Providers (Medicaid) - Click here then click the August 2017 Claims, Billing and Reimbursement Notice.
Complaints, Appeals and Grievances
Changes to Complaints Grievances and Appeals Process - Click here then click the June 2018 Tools & Resources Notice.
Provider Appeal Form – Click here then click the Medical tab.
Early and Periodic Screening Diagnosis and Treatment (EPSDT)
EPSDT Reference Guide – Click here then click the EPSDT tab.
EPSDT Codes and Assessments Wall Chart – Click here then click the EPSDT tab.
EPSDT Periodicity Schedule and Coding Matrix – Click here then click the EPSDT tab.
Validated Screening Tools for Development Delays and Autism Spectrum – Click here then click the EPSDT tab.
Asthma Formulary Update - Click here then click the April 2018 Clinical Coding and Policy Updates Notice.
Provider Statewide Preferred Drug List (PDL) FAQ’s - Click here then click the November 2019 FAQ Notice.
Aetna Better Health Special Needs Unit
Pennsylvania’s Telephonic Psychiatric Consultation Service Program - Click here then click on the link under the Attention PCPs – Enroll in TiPS for Your Pediatric Patients tab.
Healthcare Effectiveness Data and Information Set (HEDIS) Reference Guide – Click here then click the References Guides tab.
Pay for Quality (P4Q) Program – Click here then click the References Guides tab.
Special Needs Brochure – Click here then click the link.
Online Practitioner Application Form – Click here then click the Easily Submit an Online Application tab.
Pharmacy Electronic Authorization – Click here then click the Electronic Prior Authorization (EPA) tab.
Practitioner Information Change Form – Click here then click the Update your Information tab
Prior Authorization Checklist Form – Click here then click the Prior Authorization tab.
Prior Authorization Request Form – Click here then click the Prior Authorization tab.
Special Needs Unit Case Management Referral Form – Click here then click the OBNAF form link under the Medical tab.
Web Portal Registration Form – Click here then click the Secure web portal tab.
Provider Reference Information
Portal Information Web Page – Click here for the portal registration form, portal access instructions and Quick Tips.”
Availity Provider Training Webinar
Want to learn more about the Availity tool? Sign up for one of our Availity Provider Webinar training sessions today! Just click the link below to learn more.
Provider Webinars and Forums
Provider Education Webinar Series
Provider Updates & Changes You Should Be Aware Of
Wednesday, March 29, 2023
11 am EST
- CHIP Servicing Area
- Introduction of Provider Relations CHIP Team
- Updates to Roster & Provider Data Maintenance Submission Process
- Information Regarding Our Updated Member ID Cards Effective May 1, 2023
- Information Regarding How Medical Providers Can Help with the New Dental HEDIS Measures
Past Provider Education Webinars
August 2022: Medicaid Closure & CHIP Update
July 2022: PA Medicaid Closure Process & CHIP Team Introductions
June 2022: Aetna CHIP Expansion & Medicaid Closure
May 2022: Provider Credentialing
April 2022: Provider Appeals and Disputes
Provider Benefits and CHIP Expansion 2022
November/December 2021 Availity & Cultural Competency
October 2021: Provider Manual Overview
September 2021: ABH Billing Requirements, LTAC & Vendors
August 2021: Prior Authorizations
June 2021: Metropolitan Area Neighborhood Nutrition Alliance (MANNA)
May 2021: Provider Appeals and Disputes
April 2021: Availity Overview and Training
March 2021: Claims and Billing Tips for Successful Outcomes
December 2020: Cultural Competency
November 2020: Claims Inquiry Claims Research
October 2020: Operating with Integrity
September 2020: Provider Manual Review
August 2020: Special Needs Unit
June 2020: Social Determinants of Health
May 2020: Credentialing/Provider Enrollment
April 2020: Provider Complaints, Grievances & Appeals
March 2020 Webinar: Authorization Requests
February 2020 Webinar: Claims & Billing Q&A
January 2020 Webinar: Billing & Claims Reference Guide
December 2019 Webinar: Health Information Exchange and ADA
November 2019 Webinar: News & Notices
October 2019 Webinar: Authorization Search & Request
September 2019 Webinar: Portal Search
August 2019 Webinar: Credentialing Review
July 2019 Webinar: Portal Overview
Upcoming Provider Forums
April 28th 2020: Virtual Breakfast Exchange **CANCELLED**
May 13th 2020: Virtual Breakfast Exchange **CANCELLED**
June 2nd 2020: Virtual Breakfast Exchange **CANCELLED**
Past Provider Forums
NEW! Trauma Informed Care Training
Trauma Informed Care (TIC) An Introduction for Providers
Trauma Informed Care
Introduction to Trauma-Informed Care
Trauma-Informed Care in Foster Care
Electronic Visit Verification Webinar-December 17th
Join the EVV Stakeholder Webinar December 17, 2020, 10AM to Noon ET
If providers have any questions about EVV before or after the webinar, please email us at ABHProviderRelationsMailbox@AETNA.com. Put EVV Question in the subject line