8/12/2023 0 Comments Aetna timely filing 2020![]() ![]() The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. 1-88 (TTY: 711) for indemnity and PPO-based benefits plansīy clicking on “I Accept”, I acknowledge and accept that:.1-80 (TTY: 711) for HMO-based benefits plans.Or contact our Provider Service Center (staffed 8 a.m. Documents that support your position (for example, medical records and office notes).A copy of the denial letter or Explanation of Benefits letter.The reasons why you disagree with our decision.A completed copy of the appropriate form.To help us resolve the dispute, we'll need: Appeals: Requests to change a reconsideration decision, an initial utilization review decision, or an initial claim decision based on medical necessity or experimental/investigational coverage criteria.Reconsiderations: Formal reviews of claims reimbursements or coding decisions, or claims that require reprocessing.The timing of the review is prior to an appeal and incorporates state, federal, CMS and NCQA requirements. Peer to Peer Review - Aetna offers providers an opportunity to present additional information and discuss their cases with a peer-to-peer reviewer, as part of the utilization review coverage determination process.Yes, Policy number same as member ID number and also known as subscriber ID number.Health care providers can use the Aetna dispute and appeal process if they do not agree with a claim or utilization review decision. Always use the BCBS prefix on the member’s current ID card followed by the member id number.ĭoes policy number same as member ID number?.By doing it may cause delay in processing or handling the claim. Do not create one or use the BCBS prefix from another member ID card.Tips to follow, when the claim is related to BCBS prefix : Here Letter “ R” indicates BCBS FEP prefix. Here “ A2A” is BCBS alpha numeric prefix.īCBS FEP Prefix – BCBS Federal Employee Program is identified by the letter “R” followed by the number. BCBS Prefix can be classified as follows:īCBS Alpha Prefix – It’s a three letter alpha prefix followed by id number.īCBS Alpha Numeric Prefix – It’s a three letter Alpha numeric prefix followed by id number. In order to get rid of this denial or sometimes delay in processing, Provider or Billing companies has to find out the correct address by BCBS prefix from the above list before filing the claim. In that case claim may be denied as “Submit the claim to the correct address / Member ID not found”. In some case provider or billing company may file the claim to an incorrect address without checking the correct BCBS address. ![]() Suppose assume claims filed with an incorrect member ID number or BCBS prefix by Provider or Billing companies, then BCBS insurance will deny the claim stating “Incorrect member ID, please submit with an correct member ID number”. Stand-alone dental products, vision and pharmacy when delivered through an intermediary model.īCBS Prefix should be included along with ID number, exactly as it appears on the member ID card when filing the claims to insurance company.BCBS FEP – It’s indicated with letter R followed by the id number.BCBS Prefix:īCBS prefix is a three character prefixes followed by the id number except for the following products and programs. Policy number is a unique number, which is provided to their insured person by respective insurances in order for identification purposes and also for billing the healthcare claims. BCBS Prefix List Alpha & Alpha Numeric : AAA to AZZīlue Cross Blue Shield Provider Phone Number Blue Cross Blue Shield Federal Phone Number BCBS prefix List plays a vital role in filing the health care claims properly to the correct BCBS address and also to verify member’s eligibility, health insurance coverage information and to reach the correct BCBS department to check the claim status or disputes of the claim. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |