Kodi Ndizofunika Ziti Zamankhwala Zomwe Akuyenera Kudziwa Zokhudza Aetna?

Momwe Mungatumizire Malonda kwa Izi Inshuwalansi

Aetna amapereka mapulogalamu osiyanasiyana a inshuwalansi, kuphatikizapo mapulani a anthu paokha komanso pa ntchito. Amalonda a zachipatala amafunika kudziwa zambiri za momwe angayankhire ndi kukonza zomwe akulembera inshuwalansi. Nazi zambiri pazochitika zawo.

1 -

Zambiri Zokhudza Aetna kwa Ogulitsa Zamankhwala

Lembani Numeri

• Thanzi la Zamankhwala ndi Makhalidwe: Kwa mapulani a HMO ndi Medicare Advantage, funsani 1-800-624-0756. Pazinthu zonse, funsani 1-888-MD-Aetna (1-888-632-3862).
• Aetna Pharmacy Management: 1-800-238-6279
• Opereka mano: 1-800-451-7715
• Chidziwitso chodziwika kapena chiwerengero chodziwika bwino: 1-800-353-1232

Information Adresse
Aetna Inc.
151 Farmington Avenue
Hartford, CT 06156

Webusaiti ya Webusaiti
www.aetna.com/healthcare-professionals

2 -

Aetna Eligibility, Ubwino ndi Chiwerengero Chakufunsani

Kutha Kwachinsinsi Kwanthawi Yamakono (RTE)

• Amapezeka maola 24 pa tsiku, masiku 7 pa sabata
• Amapezeka kupezeka ndi osapereka chithandizo kwa odwala
• Ikulolani kuti mubweretse zopindulitsa mafunso kwa miyezi 18 isanayambe tsiku lomwe liripo

Kuyenerera, phindu ndi chikhalidwe chofunira zingatsimikizidwe m'njira ziwiri:

1. Kupyolera mu webusaiti yotetezedwa ya Aetna kudzera pa NaviNet®, kupezeka kudzera pa www.aetna.com/healthcare-professionals
2. Kupyolera mu makampani ogulitsa zipangizo zamagetsi

3 -

Momwe Mungatumizire A Precertification Kufunsira kwa Aetna

Onetsetsani pempho la precertification musanayambe kupereka mauthenga kudzera mwachindunji chamagetsi (EDI), kupyolera pa www.aetna.com/healthcare-professionals kapena patelefoni pogwiritsa ntchito nambala ya foni pa khadi lozindikiritsa membala.

Ndondomeko ndi mautumiki pamndandanda wa precertification angafunike chidziwitso ndi / kapena chitsimikizo chofotokozera.

• Chida Chofufuza Chotsatira

1. Lowani zizindikiro za CPT kuti mudziwe ngati precert ikufunika

• Electronic Precertification

1. Ipezeka maola 24 pa tsiku, Lolemba pa Loweruka
2. Landirani chiwerengero cha ID ya certification
3. Kugonjera komwe kumakana kumapatsidwa nambala yapadera yotsatira

Zambiri

4 -

Mauthenga Otsatsa Kwa Aetna

Pali njira zitatu zosavuta zowonetsera zifukwa kwa Aetna:

1. Mauthenga a zamagetsi angaperekedwe kudzera pa webusaiti yotetezedwa ya Aetna kudzera pa NaviNet®, yomwe ikupezeka kudzera pa www.aetna.com/healthcare-professionals.
2. Zomveka zamakono zingatumizedwe kudzera mu nyumba yogulitsa zipangizo zamagetsi.
3. Kulemba mapepala kungaperekedwe ku adiresi yamalonda yothandizira ya Aetna yomwe ili pamakalata a membala.

Zotsatira zapakati:

• Tumizani zamagetsi
• Phatikizani kusintha kwapadera - pa mlingo woyimira onse ndi mzere wa mndandanda wa utumiki (ngati ulipo)
• Phatikizani zifukwa zosinthira - malingaliro a mgwirizano, kuchotsedwa, coinsurance, etc. Gwiritsani ntchito zizindikiro zomwe mwapereka
• Kulipira malipiro apamtima kulipira - pa mlingo woyenera komanso mgwirizano wamtumiki (ngati alipo).

5 -

Zofunika Zowunikira Panthawi Yake

Pokhapokha ngati malamulo a boma kapena ntchito ina ikugwira ntchito:

1. Madokotala ali ndi masiku 90 kuchokera tsiku la utumiki kuti apereke chilango cholipira.
2. Mzipatala zili ndi chaka chimodzi kuchokera pa tsiku la utumiki kuti lipereke chilango cholipira.

6 -

Malingaliro Okonzedwa

Pomwe mukupanga kusintha kuzinthu zowonongedwa kale, perekani zotsutsana zowonongeka pamagetsi. Sinthani Chiwerengero cha Frequency Code ndi:
7 = Kusinthidwa kwa chiyeso choyambirira
8 = Kutsegula / kutsegula kwa chiyeso choyambirira

Pamene mukupanga kusintha kuzinthu zotsutsidwa kale, perekani zowonongeka pamapepala:

1. Kapepala "KUKHULUPIRIRA KUKHALA" pamwamba pa zomwe akunenazo
2. Imelo kwa:
   Aetna
   PO Box 14079
   Lexington, KY 40512-4079

Zambiri

7 -

Kubwezera

Tumizani chigamulo chovomerezeka ndipo Aetna adzabwezeretsa / kubwezeretsa malipiro omwe adzabwezeredwa pa ERA ndi kusinthidwa kwa chigamulo cholakwika cha chigamulo, kutsatiridwa ndi chigamulo chovomerezeka cha zomwe akufunsayo.

Zambiri

8 -

Information Aetna Claim Appeal Information

Kuwonanso

1. M'masiku a kalendala 180 a chisankho choyambirira
2. Pakadutsa masiku 3-5 amalonda atalandira pempholi. Pakadutsa masiku 30 a malonda kulandira pempholi ngati kubwereza ndi chipangizo chapadera chikufunika (mwachitsanzo, ndondomeko ya zolembera zamakono
3. Limbikitsani 1-800-624-0756 kuti mupange mapulani otsogolera a HMO ndi mapulani oyendetsera polojekiti oyambirira kapena kuitanitsa 1-888-632-3862 kuti mupange chithandizo choyenera ndi PPO.
4. Maadiresi olembetsa:
   
   States
   AL, AK, AR, AZ, CA, FL, GA, HI, ID, LA, MS, NC, NM, N, OR, SC, UT, TN, WA
   Adilesi
   Aetna PO Box 14079 Lexington, KY 40512-4079
   States
   CO, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD, ME, MI, M, MO, MT, NE, ND, NJ, NY, OH, OK, PA, SD, TX, VA, VT, WI, WV, WY
   Adilesi
   Aetna PO Box 981106 El Paso, TX 79998-1106
5. Tumizani pa intaneti kudzera mu chida chofufuza za EOB. Lowetsani kwa webusaiti yotetezera otetezera kudzera pa NaviNet® kuti mupeze chida ichi.

Kuwonekera kwa Mzere Woyamba

1. M'masiku a kalendala 60 a chisankho choganiziranso
2. Pasanathe masiku 30 antchito atalandira pempholi. Ngati zambiri zowonjezereka zikufunika, pasanathe masiku 30 a malonda kulandira zowonjezera zowonjezera
3. Limbikitsani 1-800-624-0756 kuti mupange mapulani otsogolera a HMO ndi mapulani oyendetsera polojekiti oyambirira kapena kuitanitsa 1-888-632-3862 kuti mupange chithandizo choyenera ndi PPO.
4. Lembani Aetna Provider Resolution Team PO Box 14020 Lexington, KY 40512

Kuyankhulidwa kwa Mzere 2 (kumapezeka kwa akatswiri okha)

1. Patsiku la kalendala 60 la chisankho cha Pulezidenti 1
2. Pasanathe masiku 30 antchito atalandira pempholi. Ngati zambiri zowonjezereka zikufunika, pasanathe masiku 30 a malonda kulandira zowonjezera zowonjezera
3. Limbikitsani 1-800-624-0756 kuti mupange mapulani otsogolera a HMO ndi mapulani oyendetsera polojekiti oyambirira kapena kuitanitsa 1-888-632-3862 kuti mupange chithandizo choyenera ndi PPO.
4. Lembani Aetna Provider Resolution Team PO Box 14020 Lexington, KY 40512

Zambiri