Doing Business with AetnaPresenter: Wendy Guidera

AAHAM MD Chapter November 16, 2012

2Aetna Inc.Doing Business with Aetna

Objectives

At the end of this presentation you will be able to:• Contact Aetna• Identify our members and benefits plans• Navigate our secure provider website via NaviNet®

• Registration/navigation• Transactions• Coding and account management tools

• Educational Resources• And much more!!!

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Provider Service Center

Key Benefits to the Provider• Call operations• Claim operations• Self-service solutions• Complaints and appeals• Credentialing• Provider Data Services

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Aetna at a Glance

Key tools:• Website registration and navigation• Transaction tips• Contact information• Regional information

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Aetna Benefits Products

Descriptive plan features:• PCP Selection• Referral guidelines• Benefit category

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Aetna Benefits Products

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Sample Member ID Card

Product NameReferral Requirement

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New Aetna Logo

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Aetna’s Secure Provider Website

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Aetna’s Secure Provider Website

1-888-482-8057 Contact:

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Aetna Plan Central

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Contact Us

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Health Care Professional Toolkit

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Health Care Professional Toolkit

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Electronic Transactions

AetnaProvider

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Eligibility

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Eligibility and Benefits Inquiry

Sample Provider – NPI #123456789The type of benefits you would like to see

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Eligibility Details

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Precertification

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Precertification Code Search Tool

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Precertification

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Precertification FormStep 1

Step 2

Step 3

Step 4

Step 5

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Referrals

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Referral FormStep 1

Step 2

Optional Step 3

Step 4

Optional Step 5

Step 4

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Referral Inquiry

Sample Provider – NPI #123456789

0123456789 02/07/1981

Smith John

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Online Claims and Account Management Tools

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Claims

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Claim Status Inquiry

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Claim Status Inquiry Result

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Claim Status Report

• Multiple patients• 90 days worth of claims• 18 months from date of request• Semi-real time

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Claims Status Report Result

• Claim level detail• Line level detail• Sort by claim status (finalized, denied, in process)

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Claim EOB Tool

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Electronic Explanation of Benefits

XXXXX6789 123456789

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Electronic Explanation of Benefits

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Account Management Tool

Claim History Report

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Account Management ToolMultiple Claim Reconsideration

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Claim Policy and Code Editing Tools

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Clinical and Payment Policy Code Look Up

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Clinical and Payment Policy Code Look Up

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Code Editing Tool

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Code Editing Tool

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Code Editing Tool

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Payment and Coding Policies

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Payment and Coding Policies

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Aetna’s Education Site for Health Care Professionals

www.aetnaeducation.comVisit:

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Closing

Key points from today’s session:• How to contact Aetna• How to access secure provider website via NaviNet

• Registration/navigation• Transactions – eligibility, precertification and Precertification Code

Search Tool• Account Management Tools – claim status, Claim Status Report, eEOB

and claim reconsiderations• Coding Tools – Clinical Policy Code Look Up, Code Editing Tool and

claim and payment policies

Thank you