Aetna Better Health of Virginia Claim Forms
This document provides detailed instructions for resubmission and appeal requests related to claims for Aetna Better Health of Virginia. It includes essential forms and guidelines to assist providers in resolving claim denials and payment discrepancies. Utilize these resources to ensure accurate and timely claims processing.
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How do I fill this out?
To accurately fill out this form, first gather all necessary information regarding the claim being submitted. Ensure that you have supporting documents ready to accompany the form. Finally, follow the specific instructions for each type of claim resubmission or appeal to ensure a smooth process.
How to fill out the Aetna Better Health of Virginia Claim Forms?
1
Gather necessary information regarding the claim.
2
Complete the member and provider information fields.
3
Indicate the reason for resubmission or appeal.
4
Attach supporting documentation as required.
5
Mail the completed form to the specified address.
Who needs the Aetna Better Health of Virginia Claim Forms?
1
Healthcare providers needing to resubmit claims due to denials.
2
Insurance billing specialists requiring clarification on claim status.
3
Patients seeking to correct billing discrepancies with their provider.
4
Administrators managing health insurance claims in medical facilities.
5
Legal representatives assisting clients with claim disputes.
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1
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2
Select the text or areas you want to modify.
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What are the instructions for submitting this form?
To submit this form, ensure it is filled out completely with all required attachments. You can mail it to Aetna Better Health of Virginia, PO Box 982974, El Paso, TX 79998-2960, or fax it to 1-866-669-2459. Email submissions can be sent to VAGrievanceandAppeal@Aetna.com. Always check that you follow any additional guidelines specified in the provider manual for a successful submission.
What are the important dates for this form in 2024 and 2025?
For 2024 and 2025, ensure timely submissions as follows: Appeals must be submitted within 60 days of denial. Claims resubmissions for corrected claims must be completed within 365 days of the service date. Important updates will be communicated through the Aetna Better Health website.
What is the purpose of this form?
The purpose of this form is to provide a structured means for healthcare providers to address issues related to claims submitted to Aetna Better Health of Virginia. It helps in formally documenting concerns regarding claim denials, missing information, or discrepancies in payment amounts. By providing clear guidelines and a standardized format, the form facilitates efficient processing of claims and appeals.
Tell me about this form and its components and fields line-by-line.
- 1. Member Name: Name of the member involved in the claim.
- 2. Patient Account Number: Unique identifier for the patient's account.
- 3. Member ID: Identifier assigned to the member.
- 4. Provider Name: Name of the healthcare provider submitting the claim.
- 5. Practice Name: Healthcare practice associated with the provider.
- 6. Street Address: Full street address of the practice.
- 7. City/State/Zip: Location details including city, state, and zip code.
- 8. Provider Phone Number: Contact number of the provider.
- 9. Date of Service: Date when the service was rendered.
- 10. Billed Amount: Total amount billed for the service.
- 11. Claim Number: Unique identifier for the claim.
- 12. Tax ID Number: Tax identification number of the provider.
- 13. NPI Number: National Provider Identifier for the provider.
- 14. Fax Number: Fax number for the provider's office.
- 15. Contact Name: Name of the contact person for the claim.
- 16. Contact Number: Phone number of the contact person.
What happens if I fail to submit this form?
Failing to submit this form can lead to unresolved claim issues and potential financial impacts for healthcare providers. Claims may remain denied, affecting patient billing and practice finances.
- Unresolved Claims: Claims may stay in a pending state, delaying reimbursements.
- Financial Liability: Without proper submission, providers may incur losses due to unpaid claims.
- Impact on Patient Care: Unpaid claims can hinder a provider's ability to offer quality care to patients.
How do I know when to use this form?
- 1. Claim Denial Appeals: To formally appeal a denial of a claim.
- 2. Correcting Submission Errors: To rectify mistakes found in initial claim submissions.
- 3. Disputing Payment Amounts: To address disagreements over the payment amount received.
Frequently Asked Questions
How do I resubmit a claim using this form?
To resubmit a claim, fill out the form indicating the reason for resubmission, attach the necessary documentation, and send it to the specified address.
What types of claims can I submit using this form?
You can submit claims related to itemized bills, duplicate claims, proof of timely filing, coordination of benefits, and corrected claims.
Is there a deadline for submitting an appeal?
Yes, appeals must be submitted within 60 days of the action that necessitated the appeal.
Where can I submit my completed form?
You can submit your completed form via mail, email, or fax as indicated in the instructions.
What if I need more help filling out this form?
For assistance, you can contact Claims Inquiry at 1-800-279-1878.
Do I need to include all medical records?
No, only submit medical records that are relevant to your appeal request.
How long will it take to process my request?
Aetna Better Health of Virginia aims to resolve requests within 30 days of receipt.
Can I edit this form online?
Yes, you can utilize the PrintFriendly editor to make necessary changes before submission.
Is this file available for download?
Yes, once you edit the PDF, you can download it easily.
What happens if my claim is denied?
You can appeal the denial using this form, providing necessary documentation to support your case.
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