Forms
The EFT and ERA registration Process has changed. To Register for Availity and enroll in EFT and ERA click on the Electronic Fund Transfer (EFT)/Electronic Remittance Advice (ERA) tab below.
-
Update your information online
-
Practices currently contracted with Aetna Better Health can update or change their information by submitting an online form.
Contact our Provider Relations Department at 1-866-638-1232 or email us at ABHProviderRelationsMailbox@aetna.com for help or additional information.
-
Update your information
-
Make sure your contact information is current with us. All you have to do is log in to our Secure Web Portal and completethe practitioner information change form.
If you have not registered to access to our Secure Web Portal, then fill out the Secure Web Portal registration form. Once your secure web portal registration form has been processed, you will receive your user name and password.
-
Electronic Fund Transfer (EFT)/Electronic Remittance Advice (ERA)
-
Aetna Better Health Kids is partnering with Change Healthcare to introduce the new EFT/ERA Registration Services (EERS), a better and more streamlined way for our providers to access payment services.
What is EERS?
EERS offers providers a standardized method of electronic payment and remittance while also expediting the payee enrollment and verification process. Providers will be able to use the Change Healthcare online tool to manage EFT and ERA enrollments with multiple payers on a single platform.
How does it work?
EERS gives 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. Registration can also be completed using a national provider identifier (NPI) for payment across multiple accounts.
Providers who currently use Change Healthcare as a clearinghouse will still need to complete EERS enrollment, but providers who currently have an application pending with Change Healthcare will not need to resubmit. Once enrolled, payees will have access to the Change Healthcare user guide to aid in their navigation of the new system.
How and when do I enroll?
Aetna Better Health Kids will soon migrate all payee enrollment and verification to EERS. To enroll in EERS, please visit https://payerenrollservices.com/.
For questions or concerns, please reach out to your Aetna Provider Network team, or visit the Change Healthcare FAQ page for more information.
can also send us a message via our website using the contact us form.
-
Medical
-
Prior Auth Criteria Forms
-
Pharmacy prior authorization request forms are located here.
-
Environmental Lead Investigation (ELI) form
-
Use this form to submit a request for an Environmental Lead Investigation (ELI) for our members
-
Shift Care Reporting form
-
Shift Care Reporting blank form
Please download the form to your desktop and then email it each month to ShiftCarePenn@aetna.com