Yes, you can send Aetna secondary claims electronically!
Since we support the HIPAA standard for electronic batch claims submission, we accept electronically submitted coordination of benefits (COB) claims. You can submit COB claims directly from:
Determining which plan is primary
When a patient comes into your office, start by submitting an electronic eligibility and benefits request. Our response will tell you:
Look for information about other insurance plans in the COB section of our benefits response. No matter what website you use, we’ll return the COB information we have on file. You can then use the information in the response to submit your primary claim to the correct insurance plan.
Use our COB form to print and share with your patients. This will help you collect and send COB data to us.
We participate in COB Smart™, a CAQH® Solution. For more information on COB Smart and to see a list of markets as they go live starting in fall 2013, please visit the Council for Affordable Quality Healthcare’s (CAQH) website.For tips on successfully submitting eligibility requests, visit our Electronic transactions and tools help documents page.
Tips for submitting coordination of benefits claims
To submit COB claims, your practice management system/data entry process and your clearinghouse must be able to:
Types of COB claims that can be sent electronically
* Aetna can accept both Medicare Part A and Part B claims electronically from Medicare. If the Medicare ERA or Explanation of Payment (EOP) contains an "MA18" or "N89" remark code, the Medicare carrier has automatically sent us youir claim. In these cases, you don't have to send us a Medicare Primary COB claim.
Payment information required for commercial electronic COB claims
Payment information required for Medicare primary electronic COB claims
Converting information from paper EOBs into industry-standard ERA codes
When working with a paper EOB, there's an "electronic" way to let us know how the primary payer adjudicated the claim. By using HIPAA-approved code values, you can convert payment information received from the primary payer by paper and transmit it electronically.
Note: Your paper remittance may already contain standard code values. If so, please use the codes furnished by the primary payer.
For a comprehensive listing of Adjustment Group and Adjustment Reason codes, please review Adjustment Reason Code and Adjustment Group Code Categorization Table (PDF, 122 KB). Or, visit the Washington Publishing Company at www.wpc-edi.com to view all HIPAA code lists.
For more information
You can send us an e-mail. Simply select "Contact Us" at the bottom of this page.
Or, contact the practice management support team and/or the clearinghouse you use to submit your electronic claims. Ask them if they are ready to transmit electronic COB claims. They may have their own guidelines or tips about submitting COB claims.
These documents provide information on the process of submitting electronic claims.
COB Data Fields (PDF, 147 KB) provides you with the full content of the fields required to submit electronic COB claims. This document tells you all of the needed data elements (e.g. loops, segments) found in the ASC X12N 837 Implementation Guide for submission in Version 5010.
Adjustment Reason and Adjustment Group Codes Categorization Table (PDF, 122 KB) helps you convert primary payment information received on a paper EOB into industry standard coding.
HIPAA Implementation Guide shows information on the secondary COB claims process, and you can buy it through the Accredited Standards Committee.