Skip to main content

Claims

You can file claims with us online or through the mail. We work to streamline the way we process claims. And improve payment turnaround time, so you can save time and effort. 

 

Claims reference guide (PDF)

¿Tiene alguna pregunta?

You can check your provider manual (PDF). Or call Provider Relations at 1-866-638-1232 (TTY: 711). We’re here for you Monday through Friday, 8 AM to 5 PM.

Fee schedules and billing codes

 

You can find the billing codes you need for specific services in the fee schedules.

 

Fee schedule

You’ll need to fill out a claim form.

 

You must file claims within one year from the date you provided services, unless there’s a contractual exception. For inpatient claims, the date of service refers to the member’s discharge date. You have 180 days from the paid date to resubmit a revised version of a processed claim. 

 

Online
 

You can submit claims or resubmissions online through ConnectCenter. This is our provider claims submission portal via Change Healthcare (formerly known as Emdeon). To register, visit the ConnectCenter portal and follow the prompts to “Enroll New Customer.”

 

ConnectCenter portal

 

ConnectCenter user guide (PDF)

 

Once you’ve submitted claims, you can visit the Provider Portal to review claims payment information.

 

Change Healthcare  

ChangeHealthcare.com

1-866-371-9066

 

By mail

 

Aetna Better Health Kids

Claims Submissions

PO Box 982973

El Paso, TX 79998-2973

You can resubmit a claim through ConnectCenter or by mail. If you resubmit through the ConnectCenter portal, you’ll need to mark your resubmission with a "7" in the indicator field. 

 

If you resubmit by mail, you’ll need to include these documents:

 
  • An updated copy of the claim — all lines must be rebilled
  • A copy of the original claim (reprint or copy is acceptable)
  • A copy of the remittance advice on which we denied or incorrectly paid the claim
  • A brief note describing the requested correction
  • Any other required documents

Both in-network and out-of-network providers have the right to appeal the result of a decision. You’ll want to file your appeal in writing within 60 calendar days of the reconsideration response (date of EOB).

 

You'll get a final determination letter with the appeal decision, rationale and date of the decision. We usually resolve provider appeals within 60 calendar days.

 

If the appeal decision isn’t in your favor, you can’t “balance bill” the member for services or payment that we denied for coverage. 

 

Appeal form (PDF)

 

You can file an appeal:

 

By mail

You can send your appeal to:

 

Aetna Better Health Kids

Attn: Appeals Department

PO Box 81040 

5801 Postal Road 

Cleveland, OH 44181

 

By fax
 

Fax your appeal to 1-860-754-1757.

 

Learn more about claim appeals

Also of interest: