![]() ![]() If your claim is the financial responsibility of a UnitedHealthcare West delegated entity (e.g., PMG, MSO, Hospital), then bill that entity directly for reimbursement.Ĭlaims submission requirements for reinsurance claims for hospital providers Refer to the Prompt Claims Processing section of Chapter 10: Our claims process, for more information about electronic claims submission and other EDI transactions. Mail paper CMS 1500 or UB-04s to the address listed on the member’s ID card. To avoid processing delays, you must validate with your clearinghouse for the appropriate Payer ID number or refer to your clearinghouse published Payer Lists. In some cases, the Payer ID listed on /edi may be different from the numbers issued by your clearinghouse. ![]() For a complete list of Payer IDs, refer to the Payer List for Claims. Submit your claims and encounters and primary and secondary claims as EDI transaction 837.įor UnitedHealthcare West encounters, the Payer ID is 95958. OptumInsight Connectivity Solutions, UnitedHealthcare’s managed gateway, is also available to help you begin submitting and receiving electronic transactions. For information on EDI claim submission methods and connections, go to EDI 837: Electronic Claims. Refer to our online Companion Guides for the data elements required for these transactions found on /edi. Resubmit claims in the UnitedHealthcare Provider Portal at > Sign In > Claims & Payments. Submit all professional and institutional claims and/or encounters electronically for UnitedHealthcare West and Medicare Advantage HMO product lines.ĭo not resubmit claims that were either denied or pended for additional information using EDI or paper claims forms. The payer announced the change in December 2021: Starting March 1, 2022, we will no longer pay office consultation codes 99241, 99242, 99243, 9925.EDI is the preferred method of claim submission for participating physicians and health care providers. Can you bill consult codes to Aetna?Īetna joined the long list of private payers that have cut coverage of office consults (99241-99245) today. Claims with TPL (or coordination of benefits) should be submitted within 180 days from primary insurer’s EOB date or 180 days from date of service, whichever is later. Timely Filing Requirements of Claims Corrected claims must be submitted within 365 days from the date of service. What is timely filing for corrected claims for Aetna? The updated limit will: Start on January 1, 2022. We’ve changed the standard nonparticipating-provider timely filing limit from 27 months to 12 months for traditional medical claims. What is Aetna timely filing limit for claims? Meritain is a division of Prodigy Health Group, the nation’s largest independent third-party administrator of self-funded health plans. ![]() Meritain Health will become part of the Aetna family, part of a $600 million acquisition of Meritain’s parent company announced Thursday at Aetna’s quarterly shareholders meeting. Your broker is your primary contact when it comes to your insurance policy – they should understand your situation and how to proceed. Hartford, CTAetna / Headquarters How do you process an insurance claim? You should double check me, but in general, I know the following do not pay for consult codes: Aetna, AVMED, Cigna, Department of Labor, Kaiser, Medicare, Medicare Replacement Plans, Medicaid, Meritain, United Health Care, UMR, and Tricare. What is timely filing for meritain health?Ī provider must submit any additional information or documentation as specified, within thirty-five (35) days after receipt of the notification.ĭoes meritain Health accept consult codes? Coupled with our in-house products and valued vendor partners, your customized plan includes everything you need to keep your unique employee population healthy. Today, as an independent subsidiary of Aetna and CVS, we’re able to offer access to carrier-level nationwide networks, discounts and other valuable resources.
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