Indlela Abahlinzeka Ngayo Abahlanganyeli Bangabamba Kanjani Inethiwekhi Ye-Aetna

Indlela yokufaka isicelo futhi uqinisekiswe njengomhlinzeki wenethiwekhi ye-Aetna

Odokotela nabanye abahlinzeki bangaba yingxenye yenethiwekhi yezokunakekelwa kwezempilo ye-Aetna ukuhlinzeka ngezinsizakalo zezokwelapha kumanani abo akhulayo. Uma samukelwe njengengxenye yenethiwekhi, udokotela manje ungumhlinzeki we-in-network futhi abantu abanepulani le-Aetna bazokhetha izinsiza zabo ngokukhethekile. Lokhu kuyinzuzo enamandla uma u-Aetna enabhalisile abaningi endaweni yakini.

U-Aetna uziqaphela njengomunye wabaholi besizwe emshuwalense wezempilo. Njengoba izigidi zamalungu ohlelweni lwakhe lwezokwelapha, i-Aetna iyaqhubeka nokuba khona okuqinile emazweni amaningi. Sebenzisa izinyathelo ezilandelayo njengesiqondiso sokuba yingxenye ye-Aetna Network.

Isinyathelo 1: Thola Isihlonzi Sezinhlinzeko Zikazwelonke (NPI)

Ngaphambi kokufaka isicelo sokubamba iqhaza kwinethiwekhi ka-Aetna, abahlinzeki kubandakanya odokotela, abanye ochwepheshe bezokwelapha, imikhuba yezokwelapha kanye nabahlinzeki abathile kumele bathole i-NPI.

Isihlonzi seNhlinzeko kaZwelonke noma i-NPI yinombolo eyizici eziyi-10 eziyingqikithi yokuhlonza esetshenziselwa ukuthatha indawo yabahlonza abahlinzeki njengenombolo ye-Identification Provider Unique (UPIN) ku-HIPAA ukuthengiswa okujwayelekile. Abahlinzeki bempilo bayadingeka ngokumiswa kwe-HIPAA ukuthola i-NPI.

Uma ungenalo i-NPI, faka enye ku-nppes.cms.hhs.gov noma shayela i-NPI Enumerator ngo-1-800-465-3203.

Isinyathelo 2: Thumela isicelo sokubamba iqhaza

I-Aetna idinga noma yimuphi umhlinzeki onentshisekelo ekuhlanganyeleni kwinethiwekhi ye-Aetna ukuhambisa isicelo sokubamba iqhaza ngaphambi kokuhambisa isicelo. Isicelo sokubamba iqhaza sihlolwe ukuze sinqume isidingo somhlinzeki ohlanganyele endaweni yehhovisi lakho lezokwelapha. Thintana nalokhu okulandelayo ukuhambisa isicelo sakho sodokotela kanye nabanye ochwepheshe bezokwelapha:

1. Gcwalisa ifomu le-Application Plans Isicelo se-Medical Plans kwi-website ye-Aetna
2. Xhumana nommeleli ku-1-800-353-1232
3. Isikhungo sezokwelapha kumele sixhumana ne-Aetna Provider Service Centre ngo-1-888-632-3862.

Qinisekisa ukuthi ube ne-ID yakho yehhovisi lezokwelapha kanye nenombolo yelayisensi yezokwelapha ngakwesokunene. Uma isicelo sakho samukelwe, i-Aetna izothumela isivumelwano sakho somhlinzeki nge-imeyili sokubukeza kwakho. Kudingeka isignesha.

Isinyathelo sesi-3: Joyina i-CAQH Universal Provider Datasource (UPD)

I-CAQH UPD iyithuluzi le-inthanethi elenzelwe ukunciphisa inqubo yokuqoqa ulwazi oludingwa izinhlelo zempilo zomhlinzeki wokuqinisekisa nokuningi okuningi. Le nqubo ivimbela abahlinzeki ukuthi bahambise ulwazi olufanayo kumaphrojekthi amaningi omshwalense wezempilo. Amalungu angaqedela futhi athumele ulwazi lwabo kuzo zonke izinhlelo zezempilo mahhala.

• Thola ID ye-Provider CAQH ngokubiza i-CAQH Desk Support (888) 599-1771 noma i-imeyili caqh.updhelp@acsgs.com
• Ngena ngemvume ku-upd.caqh.org/oas/
• Landela imiyalelo ukuqedela nokuvuselela ukubhalisa

Isinyathelo 4: Qedela isicelo

Inqubo yesicelo ingagcwaliswa ngokuphelele kwi-Inthanethi. Uma isicelo sesiphelile futhi siqinisekisiwe, kuzodingeka ugunyaze i-Aetna ukuthola ukufinyelela kokubhalisa kwakho nolunye ulwazi. Inqubo yonke akufanele ithathe isikhathi esingaphezu kwamahora amabili ukuqedela. I-module ibuye yenzelwe ukulondoloza ulwazi lwakho uma udinga ukuqedela uhlelo lokusebenza ngezikhathi eziningi.

Idesksi yokusekela i-CAQH iyatholakala ukukusiza uma udinga usizo ngesikhathi senqubo.

Isinyathelo 5: Hlanganisa yonke imibhalo yokusekela

Noma yimaphi amadokhumenti asekelayo kufanele asefekselwe ku-CAQH ku- (866) 293-0414. Uzodinga:

• I-Curriculum Vitae
• Ilayisensi yezokwelapha
• Isitifiketi se-DEA
• Isitifiketi se-CDS
• Ifomu le-IRS W-9
• Ishidi leshidi lomshwalense wokungahambi kahle
• Ukufingqa kwanoma yiziphi izinkinga ezilindile noma ezihleliwe

I-Aetna inenqubo ehlukile yoCredentialing. I-CVO ye-Aetna (Credentialing Verification Organisation) ihlola iziqu zomfakisicelo ngamunye ngaphambi kokuba umhlinzeki angamukelekile ngokuhlanganyela kwinethiwekhi ye-Aetna. Ngaphandle kolwazi oluceliwe yi-CAQH, i-Aetna izophinde ibuyekeze ikhono lobuchwepheshe nokuziphatha.

Olunye ulwazi olufanele

• Inqubo yonke ingathatha izinyanga ezintathu kuya kweziyisithupha
• Isaziso esibhaliwe sizothunyelwa kumhlinzeki uma kwenziwa isinqumo
• Ukuze uthole ulwazi oluthe xaxa mayelana nehhovisi lakho lezokwelapha ekubeni umhlinzeki ohlanganyele we-Aetna vakashela i-www.aetna.com ne-www.caqh.org.