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Questions?
You can check your provider manual (PDF). Or call Provider Relations at 1-888-348-2922 (TTY: 711). We’re here for you Monday through Friday, 8:30 AM to 5 PM.
Claims processes
Learn more about how we handle certain types of claims.
You’ll need to fill out a claim form.
You must file claims within 1 year from the date you provided services, unless there’s a contractual exception. For inpatient claims, the date of service refers to the member’s discharge date. You have 120 days from the paid date to resubmit a revised version of a processed claim.
Online
You can submit claims or resubmissions online through ConnectCenter. This is our provider claims submission portal via Change Healthcare (formerly known as Emdeon). To register, visit the ConnectCenter portal and follow the prompts to “Enroll New Customer.”
ConnectCenter user guide (PDF)
Once you’ve submitted claims, you can visit the Provider Portal to review claims payment information.
Change Healthcare
Electronically
You can submit claims electronically through a clearinghouse. Emdeon is the EDI (electronic data interchange) vendor we use. Questions about submitting claims electronically? Just call us at 1-888-348-2922 (TTY: 711).
By mail
You can also mail hard copy claims or resubmissions to:
Aetna Better Health® of West Virginia
PO Box 982965
El Paso, TX 79998-2965
Mark resubmitted claims clearly with “resubmission” to avoid denial as a duplicate.
You can resubmit a claim through ConnectCenter or by mail. If you resubmit through the ConnectCenter portal, you’ll need to mark your resubmission with a "7” in the indicator field.
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
Mark resubmitted claims clearly with “resubmission” to avoid denial as a duplicate.
In-network providers have the right to appeal the result of a decision. You’ll want to file your appeal in writing within 90 calendar days of the Notice of Action.
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.
Before filing an appeal: You should contact Claims Inquiry/Claims Research (CICR) as the first step to clarify any denials or other actions relevant to the claim. In many cases, claim denials are the result of inaccurate filing practices, so be sure to call beforehand to check on claim information. Just call 1-888-348-2922 (TTY: 711). Or check your provider manual for more information.
Online
If you submit online, you’ll need to do it through the ConnectCenter portal. Be sure to mark your resubmission with a "7” in the indicator field.
By mail
If you submit by mail, 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
Be aware that we:
- Process and decide claims within 30 days of receipt. This includes processing clean payments for professional and institutional claim submissions
- Process and decide claim reconsiderations within 120 days of the resolution date on the original (clean) claim’s EOB
- Identify a Coordination of Benefit (COB) resubmission as a claim previously denied for other insurance info, or originally paid as primary without coordination of benefits
- Process and decide COB claim reconsiderations within 120 days from the disposition date on the primary carrier’s EOB or response letter
Electronic funds transfer (EFT)
EFT makes it possible for us to deposit electronic payments directly into your bank account. You can get an EFT form here or on our Provider Portal. Some benefits of setting up an EFT include:
Improved payment consistency
Fast, accurate and secure transactions
Once you complete the EFT form, you can submit it by:
- Emailing us
- Faxing us at 1-844-705-2352
You can get and Enroll in Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT)
You’ll want to allow up to 15 days for us to process your EFT form. Once processing is complete, we’ll send you a confirmation letter.
Electronic remittance advice (ERA)
ERA is an electronic file that contains claim payment and remittance info sent to your office. The benefits of an ERA include:
- Reduced manual posting of claim payment info, which saves you time and money, while improving efficiency
- No need for paper Explanation of Benefits (EOB) statements
Once you complete the ERA form, you can send it by:
- Faxing us at 1-866-810-8476
You can get and Enroll in Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT)
You’ll want to allow up to 15 days for us to process your ERA form. Once processing is complete, we’ll send you a confirmation letter.
Helpful resources
International Classification of Diseases (ICD-10) resources:
Centers for Medicare & Medicaid Services (CMS) ICD-10 resources
Conversion tool for Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to ICD-10 (PDF)