![]() Health insurance plans contain exclusions and limitations. Step 5: Payment on filed claims for covered expenses will be mailed directly. Provider participation may change without notice. If the Provider does not file the claim directly with Aetna Student Health. Providers are independent contractors and are not agents of Banner|Aetna. An application must be completed to obtain coverage. 98point6 is available to members age 1-17 when an adult parent or guardian is also enrolled in the plan. ![]() Access to 98point6 ® is not included in all plans. Aetna and Banner Health provide certain management services to Banner|Aetna. Aetna, CVS Pharmacy ® and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health ® family of companies.ĩ8point6 ® is a registered trademark of 98point6 Inc. Each insurer has sole financial responsibility for its own products. Banner|Aetna is an affiliate of Banner Health and of Aetna Life Insurance Company and its affiliates (Aetna). Health benefits and health insurance plans are offered, underwritten, and/or administered by Banner Health and Aetna Health Insurance Company and/or Banner Health and Aetna Health Plan Inc. Our law department makes the final determination if there is any question regarding the applicability of any particular law. on a claim is used to determine the timely filing date. If our policy varies from the applicable laws or regulations of an individual state, the requirements of the state regulation supersede our policy when they apply to the member’s plan. Claims 180 days from date of denial or payment Amerigroup Initial Claim. The member appeal process applies to appeals related to pre-service or concurrent medical necessity decisions.Īpplication of state laws and regulations For these issues, the practitioner and organizational provider appeal process only applies to appeals received subsequent to the services being rendered. ![]() These issues relate to decisions made during the precertification, concurrent or retrospective review processes for services that require precertification. For example, issues related to the provider contract, our claims payment policies, or processing errors. Its best to submit claims as soon as possible. These issues relate to all decisions made during the claims adjudication process. This quick reference guide shows you when and where to submit disputes Issue types
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