Claims

You will need to submit a CMS approved claims form - CMS-1500 (HCFA) for professional medical claims or a CMS-1450 (UB-04) for submitting institutional claims for inpatient and outpatient services. Please use the payer ID number 128OK and adhere to all CMS guidelines on claims forms and electronic/paper billing. 

You can file claims for retro members through the normal claims process. These are members who are retroactively eligible for coverage.
 

Online
 

Availity is our provider portal, which provides functionality for the management of patients, claims, authorizations and referrals. To submit claims via Availity, choose the button labeled “Medicaid Claim Submission – Office Ally.”

Here you can submit claims through your Office Ally account or through your own clearinghouse, so long as it has a reciprocal relationship with Office Ally. To avoid incurring fees setting up an Office Ally account, use the Aetna link. 

If you don’t have an Office Ally account or an account with a clearinghouse that reciprocates with Office Ally, your claim will be rejected. We may not even know you've tried to submit a claim.

By mail
 

You can also mail hard copy claims or resubmissions to our claims address:

Aetna Better Health of Oklahoma 

PO Box 983110

El Paso, TX 79998-3110

Mark resubmitted claims clearly with “resubmission” to avoid denial as a duplicate.

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

• An updated copy of the claim — all lines must be rebilled
• A copy of the original claim (reprint or copy is acceptable)
• A copy of the remittance advice on which we denied or incorrectly paid the claim
• A brief note describing the requested correction
• Any other required documents

Both in-network and out-of-network providers have the right to appeal the result of a decision. You’ll want to file your appeal in writing within 30 calendar days of the reconsideration response (date of EOB).

You'll get a final determination letter with the appeal decision, rationale and date of the decision. We usually resolve provider appeals within 30 calendar days.

If the appeal decision isn’t in your favor, you can’t “balance bill” the member for services or payment that we denied for coverage. 

You can file an appeal:

By phone

Just call ${provider_services_phone}.

By mail

You can send your appeal to:

Aetna Better Health® of Oklahoma

PO Box 81040 

5801 Postal Road

Cleveland, OH 44181

By fax

Fax your appeal to 1-833-805-3310.

By email

Email us your appeal.

Learn more about claim appeals

You can file a resubmission verbally or in writing within 30 calendar days of remittance advice. Send written reconsiderations through the provider portal or by:
 

Mail

Aetna Better Health of Oklahoma
Attn: Reconsiderations
PO Box 983110
El Paso, TX 79998-3110

Email

Email us the reconsideration. 

Fax

Fax the reconsideration to 1-833-805-3310.

The Appeals and Grievance Manager coordinates and manages provider reconsiderations. They’ll let you know about the status of your reconsideration. They’ll also acknowledge your reconsideration request within 5 business days.
 

When you send a reconsideration, be sure to include:
 

• A claim form for each reconsideration 
• A copy of the remit/Explanation of Benefits (EOB) page for each resubmitted claim, with a brief note about each claim you’re resubmitting 
• Any information that the health plan previously requested

EERS offers payees multiple ways to set up EFT and ERA 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 SoonerSelect 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.