Aetna Better Health has recently provided the following informaiton:
Please review the information below regarding EVICORE authorizations and appeal guidelines.
Medical Prior Authorizations:
Note: If a claim denies not authorized, providers must request an authorization before submitting a provider appeal. If the retro authorization request is denied, a provider appeal can be submitted to the health plan.
High Tech Radiology Authorizations
- Phone: 1-888-693-3211
- Client & Provider Opertions team at 800-575-4517 or email firstname.lastname@example.org.
- Prior Authorization Denials- Please use the Request Form on EVICORE’s website to submit additional clinical information that justifies the medical necessity of a denied case.
- Retro Authorization requests to EVIROE
- Can be submitted at any time
- Requests submitted beyond 90 calendar days from the DOS will be admin denied
- Turn around time: 14 calendar days
- Grievance and Appeals is handled by the Health Plan:
- Fax: 1-860-975-3615
- Mail: Aetna Better Health of Michigan, Grievance & Appeal Manager, 1333 Gratiot Ave, Suite 400, Detroit, MI 48207
Also included the provider presentation found on the eviCore ABH MI provider site – at: https://www.evicore.com/implementation/healthplan/aetna-better-health/michiganABH