索赔

您可以通过电子方式或邮寄方式向我们提出索赔申请。我们致力于简化我们处理索赔的方式。改善付款的处理时间，以节省您的时间和精力。

有疑问？

您只要查阅您的医疗服务提供者手册 (PDF)。或致电医疗服务提供者关系部，电话： 1-855-456-9126 (TTY: 711)。我们从周一至周五上午 9 点至下午 5 点为您提供服务。

收费表和计费代码

您可以在收费表中找到特定服务所需的计费代码。

收费表

家庭护理和社会日托料服务提供者需要在 UB 04 上提交所有索赔。如果签约医疗机构未能正确提交，索赔可能会受到延迟或拒绝。

You’ll need to fill out a claim form.

You must file claims within 120 days from the date you provided services, unless there’s a contractual exception.

在线

Availity is our provider portal, which provides functionality for the management of patients, claims, authorizations and referrals. To submit claims online via Availity, choose the button labeled “Medicaid Claim Submission – Office Ally.” This link will take you directly to the Office Ally website where you can submit claims using their online claim entry feature or by uploading a claim file.

Providers must have an Office Ally account to submit claims online. Submission of your Aetna Better Health of New York claims using Office Ally is free of charge. The status of claims submitted online should be managed through your Office Ally Account.

邮寄

您还可以将纸质的索赔或重新提交的索賠邮寄至：

Aetna Better Health 索赔 

PO Box 982972 

El Paso, TX 79998-2972

将重新提交的索赔清楚标记为“重新提交”，以避免因重复提交而被拒绝。

You can resubmit a claim through Availity or by mail. If you resubmit by mail, you’ll need to include these documents:

索赔重新提交和争议表 (PDF)
更新的索赔副本——所有行项目必须重新计费
原始索赔的副本（重印件或复印件均可接受）
我们拒绝或未正确支付索赔的汇款通知副本

一份描述所请求更正的简短说明
任何其他必需的文件

网络内和网络外的医疗服务提供者都有权对决定结果提出异议。建议您在收到复议答复（EOB 日期）后 60 个日历日内，以书面形式提交您的异议。

您将收到一封最终裁决信，信中包含决定、理由和决定日期。我们通常在 30 个日历日内解决医疗服务提供者争议。

如果争议的决定不利于您，您不能因我们拒绝承保的服务或付款而向保户“收取额外的费用”。

您可以通过以下方式对索赔提出异议：

通过邮件

您可以将您的异议发送至：

Aetna Better Health of NY - 医疗服务提供者关系部

注意：医疗服务提供者争议

101 Park Ave, 15th Floor

New York, NY 10178

通过传真

请将争议传真至 1-855-264-3822 或者 1-860-754-9121。

如果您因为任何原因对我们的政策、程序或管理职能的任何方面感到不满，您可以提出投诉。您可以在我们的投诉与申诉页面了解更多关于投诉流程的信息。

了解有关投诉的更多信息

电子转账 (EFT)/电子汇款通知(ERA) 注册服务 (EERS)

EERS offers our providers a more streamlined way to access payment services. It gives you a standardized method of electronic payment and remittance while also expediting the payee enrollment and verification process.

EFT makes it possible for us to deposit electronic payments directly into your bank account. Some benefits of setting up an EFT include:

改善的支付一致性
快速、准确且安全的交易

ERA is an electronic file that contains claim payment and remittance info sent to your office. The benefits of an ERA include:

减少手动发布索赔支付信息，这可为您节省时间和金钱，同时还能提高效率
不再需要纸质版的福利说明书 (EOB)

EERS offers payees multiple ways to set up EFT and ERA in order to receive transactions from multiple payers. If a provider’s tax identification number (TIN) is active in multiple states, a single registration will auto-enroll the payee for multiple payers. You can also complete registration using a national provider identifier (NPI) for payment across multiple accounts.

ECHO Health processes and distributes claims payments to providers. To enroll in EERS, visit the Aetna Better Health ECHO portal. You can manage electronic funds transfer (EFT) and electronic remittance advice (ERA) enrollments with multiple payers on a single platform.

Sign up for EFT

To sign up for EFT, you’ll need to provide an ECHO payment draft number and payment amount for security reasons as part of the enrollment authentication. Find the ECHO draft number on all provider Explanation of Provider Payments (EPP), typically above your first claim on the EPP. Haven’t received a payment from ECHO before? You’ll receive a paper check with a draft number you can use to register after receiving your first payment.

Update your payment or ERA distribution preferences

You can update your preferences on the dedicated Aetna Better Health ECHO portal.

Use our portal to avoid fees

Fees apply when you choose to enroll in ECHO’s ACH all payer program. Be sure to use the Aetna Better Health ECHO portal for no-fee processing. You can confirm you’re on our portal when you see “Aetna Better Health” at the top left of the page.

Be aware — you may see a 48-hour delay between the time you receive a payment, and an ERA is available.