Yiziphi Izidakamizwa Zempilo Okudingeka Zizazi Nge-Aetna

Indlela Yokuthumela Izimangalo Kulo Mshwalense

I-Aetna inikeza izinhlelo ezihlukahlukene zemishwalense yezempilo, kuhlanganise nalabo ngabanye kanye nezinhlelo ezixhaswe emsebenzini. Abathengisi bezokwelapha cishe badinga ulwazi mayelana nendlela yokukhokhisa futhi baqhube izimangalo kulo mshwalense. Nansi ulwazi ngezinqubo zabo.

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Ulwazi olujwayelekile nge-Aetna yeBill Billers

Imininingwane yokuxhumana

• Impilo yokwelashwa nokuziphatha: Ngezinhlelo ze-HMO-based and Medicare Advantage, shayela u-1-800-624-0756. Kuzo zonke ezinye izinhlelo, shayela u-1-888-MD-Aetna (1-888-632-3862).
• Ukuphathwa kwe-Aetna Pharmacy: 1-800-238-6279
• Abahlinzeki bamazinyo: 1-800-451-7715
• I-Credentialing noma isimo sokubuyiselwa kabusha: 1-800-353-1232

Ulwazi lwekheli
Aetna Inc.
151 Farmington Avenue
Hartford, CT 06156

Ikheli lewebhu
www.aetna.com/healthcare-professionals

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Ukufaneleka kwe-Aetna, Izinzuzo nesimo sesimangalo

Ukufaneleka kwe-Real Time Time (RTE)

• Iyatholakala amahora angu-24 ngosuku, izinsuku ezingu-7 ngesonto
• Itholakala ukuze iqhaza futhi ingabandakanyi abahlinzeki bezempilo
• Ikuvumela ukuba uthumele izinzuzo zemibuzo kuze kube izinyanga ezingu-18 ngaphambi kosuku lwamanje

Ukufaneleka, izinzuzo kanye nesimo sokumangalelwa kungaqinisekiswa ngezindlela ezimbili:

1. Nge-website ye-Aetna ephephile nge-provider nge-NaviNet®, etholakala nge-www.aetna.com/healthcare-professionals
2. Ngomthengisi we-electronic / indlu yokuhlanza

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Indlela yokuthumela isicelo sokufaka isicelo ngaphambi kwe-Aetna

Thumela izicelo ze-precertification ngaphambi kokunikeza izinsizakalo ngokusebenzisa ukushintshaniswa kwedatha ye-elektroniki (EDI), ngokusebenzisa www.aetna.com/healthcare-professionals noma ngocingo usebenzisa inombolo yocingo ekhadini lokuhlonza ilungu.

Izinqubo kanye nezinsizakalo ohlwini lwezingqungquthela zingadinga isaziso kanye / noma ukuzimisela kokuthumela.

• Ithuluzi Lokusesha I-Precertification Code

1. Faka amakhodi we-CPT ukuze uthole ukuthi i-precert iyadingeka yini

• I-Electronic Precertification

1. Itholakala amahora angu-24 ngosuku, ngoMsombuluko mhla ngoMgqibelo
2. Thola inombolo ye-ID yesitifiketi
3. Ukuhambisa okulahla kunikezwa inombolo elandelwayo yokulandelela

Okuningi

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Ulwazi lokukhokha lwe-Aetna

Kunezindlela ezintathu ezilula zokuhambisa izimangalo ku-Aetna:

1. Izimangalo ze-elekthronikhi zingathunyelwa ngewebhusayithi ye-Aetna ephephile ngokuhlinzeka nge-NaviNet®, etholakala nge-www.aetna.com/healthcare-professionals.
2. Izimangalo ze-elekthronikhi zingathunyelwa ngokusebenzisa umthengisi / indlu yokuhlanza.
3. Izicelo zephepha zingathunyelwa ekhelini le-Aetna lokuposa le-imeyili elibalulwe ekhadini le-ID yelunga.

Izimangalo zesekondari:

• Thumela nge-elektroniki
• Faka phakathi ukulungiswa kwemali - kokubili kwezinga lokumanga kanye nezinga lesevisi yesevisi (uma likhona)
• Faka izizathu zokulungiswa - ukubophezela kwesivumelwano, ukuchithwa, ukuqinisekiswa kwemali, njll. Sebenzisa amakhodi anikezwe imali yokukhokhwa komkhokhi oyinhloko
• Isamba esikhokhelwayo sokukhokha esiyinhloko - kokubili izinga lokumangalelwa kanye nezinga lezinsizakalo zenkonzo (uma likhona).

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Izidingo Zokuthumela Okwamanje

Ngaphandle kokuthi umthetho wezwe noma omunye okungafani kusebenza:

1. Odokotela banezinsuku ezingu-90 kusukela ngosuku lomsebenzi ukuhambisa isimangalo sokukhokha.
2. Izibhedlela zinonyaka owodwa kusukela ngosuku lwenkonzo ukuhambisa isimangalo sokukhokha.

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Izimangalo ezilungisiwe

Uma wenza izinguquko kumangalo akhokhelwa ngaphambilini, thumela izicelo ezilungisiwe ngekhompyutha. Buyekeza i-Code Frequency Code nge:
7 = Ukufakwa kwesimangalo esandulele
8 = Awukwazi / ukukhansela kwesimangalo esandulele

Uma wenza izinguquko kumangalo aphikisiwe ngaphambilini, faka izimangalo ezilungisiwe ephepheni:

1. Isitembu "UKUKHULULEKWA OKUHLEKILE" phezulu kwesimangalo
2. Imeyili ku:
   I-Aetna
   PO Box 14079
   I-Lexington, KY 40512-4079

Okuningi

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Ukubuyiselwa kwemali

Thumela isimangalo esilungisiwe futhi u-Aetna uzophinde abuyele / aphinde akhokhe imali ekhokhwa ngokweqile ezokwaziswa nge-ERA ngokuguqulwa kwesimangalo esifanele sokumangalelwa, kulandelwe ukugwetshwa okulungisiwe kwesimangalo.

Okuningi

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Ulwazi Lokudluliswa Kwemangalo ye-Aetna

Ukubukwa kabusha

1. Ngaphakathi kwezinsuku ezingu-180 zekhalenda yesinqumo sokuqala sokumangalelwa
2. Kungakapheli izinsuku ezingu-3-5 zebhizinisi kokuthola isicelo. Kungakapheli izinsuku ezingu-30 zebhizinisi zokuthola isicelo uma ukubuyekezwa yiyunithi ekhethekile kuyadingeka (ngokwesibonelo, ukubuyekezwa kwekhodi yezokwelapha
3. Shayela u-1-800-624-0756 ngezinhlelo zezinzuzo ezisekelwe kwi-HMO kanye namasu we-WA Primary Primary Choice noma shayela u-1-888-632-3862 ngezinhlelo zokuhlomula nezinzuzo ezisekelwe e-PPO
4. Amakheli okuthumela:
   
   States
   AL, AK, AR, AZ, CA, FL, GA, HI, ID, LA, MS, NC, NM, NV, OR, SC, UT, TN, WA
   Ikheli
   I-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, NH, NJ, NY, OH, OK, PA, RI, SD, TX, VA, VT, WI, WV, WY
   Ikheli
   I-Aetna PO Box 981106 El Paso, TX 79998-1106
5. Thumela ku-inthanethi ngokusebenzisa ithuluzi lokusesha le-EOB. Ngena ku-website yomhlinzeki ephephile nge-NaviNet® ukuze ufinyelele leli thuluzi.

Isikhalazo seNqanaba 1

1. Kungakapheli izinsuku ezingu-60 zekhalenda yesinqumo sokucubungula kabusha
2. Kungakapheli izinsuku ezingu-30 zebhizinisi kokuthola isicelo. Uma ulwazi olwengeziwe luyadingeka, kungakapheli izinsuku ezingu-30 zebhizinisi ukuthola ulwazi olwengeziwe oluceliwe
3. Shayela u-1-800-624-0756 ngezinhlelo zezinzuzo ezisekelwe kwi-HMO kanye namasu we-WA Primary Primary Choice noma shayela u-1-888-632-3862 ngezinhlelo zokuhlomula nezinzuzo ezisekelwe e-PPO
4. Bhala Ithimba Lokuxazulula Umhlinzeki We-Aetna PO Box 14020 Lexington, KY 40512

Isikhalazo seNqanaba 2 (sitholakala kuphela kubadobi)

1. Kungakapheli izinsuku ezingu-60 zekhalenda zesinqumo se-appeal 1
2. Kungakapheli izinsuku ezingu-30 zebhizinisi kokuthola isicelo. Uma ulwazi olwengeziwe luyadingeka, kungakapheli izinsuku ezingu-30 zebhizinisi ukuthola ulwazi olwengeziwe oluceliwe
3. Shayela u-1-800-624-0756 ngezinhlelo zezinzuzo ezisekelwe kwi-HMO kanye namasu we-WA Primary Primary Choice noma shayela u-1-888-632-3862 ngezinhlelo zokuhlomula nezinzuzo ezisekelwe e-PPO
4. Bhala Ithimba Lokuxazulula Umhlinzeki We-Aetna PO Box 14020 Lexington, KY 40512

Okuningi