Medicare PPO for nonpar providers
Increased membership projected in our Aetna Medicare Plan (PPO)
We are projecting an increase in membership in our Medicare Advantage (MA) PPO plans on a national basis. Our MA PPO plan members have the flexibility of seeing either nonparticipating or participating providers who are eligible to receive payment from Medicare. Several large employers have already signed on to cover their Medicare-eligible retirees under these MA PPO plans. As a result, you may see an increase in patients with Aetna Medicare Plan (PPO) coverage. Learn more (PDF, 1.1 MB).
Aetna has a formal process for Medicare Advantage Plan provider dispute resolution for non-contracted providers. Learn more (PDF, 70 KB) about Medicare Advantage Plan provider dispute resolution.To view all available Aetna Medicare Advantage plans and benefit information by zip code, please visit www.aetnamedicare.com
Health care professionals and organizational health care providers can dispute adverse decisions. The information below explains when and how to submit a dispute. It applies to all our medical benefits plans. (Please note that state requirements take precedence when they differ from our policy.)
Aetna has a formal process that allows participating and non-participating dentists to file an appeal. Learn more about Aetna's Provider Appeal Process.
Aetna has a formal process for Medicare Advantage Plan provider payment dispute resolution for non-contracted providers. (PDF, 70 KB)
Aetna has a formal process for Aetna has a formal process for Medicare Advantage Plan provider payment appeal resolution for non-contracted providers.. (PDF, 137 KB)
More online resources are available on Aetna's secure website for physicians, hospitals and health care professionals. Once logged in, choose “Doing Business with Aetna,” then “Aetna Benefit Products,” followed by “Aetna Medicare.”
Find Member information on www.aetnamedicare.com.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies. The Aetna companies that offer, underwrite, or administer benefits coverage include Aetna Life Insurance Company.
Alternate Delivery of Notice of Medicare Non-Coverage (NOMNC) form (PDF, 121 KB) Use this form to document that you gave the NOMNC to someone other than the member. You must give the NOMNC to the member or their appointed or authorized representative at least two calendar days before the date that services will be terminated.
If the member files a Fast Track appeal with the Quality Improvement Organization (QIO), fax this form and a copy of the NOMNC letter to:
New! CMS announces National Coverage Determinations (PDF, 77 KB)
SRMP Provider Refresher (PDF, 1.11 MB)