Aetna Better Health

ID Card: Front of card ID Card: Back of card
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Aetna Better Health of Michigan home page website: https://www.aetnabetterhealth.com/michigan
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Aetna Better Health of Michigan Provider Resources: https://www.aetnabetterhealth.com/michigan/providers/
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Join Our Network, Prior Authorization, Provider Manual, Case/Disease Management, Clinical Practice Guidelines, Provider Portal, Forms, News & Notices, Newsletters, Claims, Training, Resources
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Availity home page web Portal: www.availity.com
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Log in to Essentials or call 1-800-282-4528
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Availity Portal Tools & Resources:
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Eligibility, Claims, Prior Authorizations, PAR Provider Disputes, Grievance and Appeals, Panel Roster and more
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How to verify member eligibility, PCP assignment, benefits, co-pays/deductibles:
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State CHAMPS website: www.michigan.gov
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ABH Provider Portal: https://www.aetnabetterhealth.com/michigan/find-provider
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Availity Secure Portal: www.availity.com
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How to File a Claim:
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Electronic Claims Submission (EDI)
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Electronic Claims Submission: Change Health (Emdeon) is the EDI vendor we use Medicare and Medicaid https://www.changehealthcare.com/
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Payer ID: 128MI
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Paper Claims:
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Aetna Better Health OF Michigan PO Box 982963 El Paso, TX 79998-2963
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Claims Timely Filing:
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New Claim: within 365 days from Date of Service
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COB Claim: within 365 from the date of the COB remittance advice
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Claim Resubmission: within 180 days from the date of payment or denial
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Appeals and reconsiderations: 180 days from the original denial for appeal and reconsiderations
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Prior Authorization online tool: https://www.aetnabetterhealth.com/michigan/providers/prior-authorization
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Select Prior Authorizations to determine if prior authorization (PA) is required
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Enter CPT or HCPCS Code (s) up to six can be entered
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Select Plan
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ABH of Michigan – MMP Duals (Medicare/Medicaid)
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Michigan Medicaid-Medicaid/Healthy MI
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Phone: 1-855-676-5772 Fax: 1-844-241-2495
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Provider Appeal:
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Phone: 866-316-3784 Fax: 866-889-7517
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Mail: Aetna Better Health of Michigan Attn: Provider Grievance
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PO Box 818070 5801 Postal Road Cleveland, OH 44181-0040
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Email: MIAppealsandGrievances@aetna.com
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Secure Portal: https://www.aetnabetterhealth.com/michigan/providers/portal
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Claims Inquiry Claims Research (CICR) Department: benefits, eligibility, claim status, appeal status, check tracers, remits, COB, Billing and Coding
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MI Duals: 1-855-676-5772 Medicaid/Healthy MI: 1-866-316-3784
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Vendors:
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CVS Health Pharmacy Benefits Manager: 1-800-552-8159
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DentaQuest Dental Benefits Manager: 1-866-316-3784
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VSP Vision Benefits Manager: 1-800-877-7195
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Medical Transportation Management: 1-844-549-8347
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eviCore Health Radiology Benefits Manager: 1-888-693-3211
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Provider Representatives:
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Patti Pogodzinski: pogodzinskipatti@aetna.com