Dispute & Appeal Process:
State exceptions to filing standard

In the absence of an exception below, Aetna's 180-day dispute filing standard will apply. The exceptions below apply to requests regarding members covered under fully insured plans only.

State	Abbrv.	Exception Applies To	Time Allowed to File an Initial Claim Payment Dispute
Arizona	AZ	All providers -- participating and nonparticipating	1 year
California HMO	CA	All providers -- participating and nonparticipating, when the request relates to an HMO member and the date of service is on/after 1-1-04	365 days
California Traditional	CA	All providers -- participating and nonparticipating, when the request relates to a traditional member and the appeal is received on/after 6/29/09	180 days
Colorado	CO	All providers -- participating and nonparticipating	12 months
Florida	FL	All participating or nonparticipating licensed physicians or physician assistants (or practitioners licensed under FL Ch. 458), osteopathic physicians, chiropractors, podiatrists or dentists	12 months (does not apply to facilities)
Georgia	GA	All providers -- participating and nonparticipating	12 months from date of claim payment
Indiana	IN	All providers -- participating and nonparticipating, effective with claims paid on or after 7/1/06	2 years (from claim payment date)
Kentucky	KY	participating providers only	2 years
Maryland	MD	All providers -- participating and nonparticipating	365 days
New Jersey	NJ	All providers treating fully-insured NJ contracted members and submitting their dispute using the "Health Care Provider Application to Appeal a Claims Determination Form" will be eligible for review by New Jersey’s Program for Independent Claims Payment Arbitration (PICPA).	90 calendar days from the notice of the disputed claim determination
New Jersey	NJ	No health care provider treating fully-insured NJ contracted members shall seek reimbursement from a payer or covered person for underpayment of a claim later than 18 months from the date the first payment on the claim was made. After 90 calendar days from the notice of the disputed claim determination the provider shall not be eligible for PICPA (see above).	18 months from the date the first payment of a claim was made
North Carolina	NC	All providers -- participating and nonparticipating	2 years from the original claim payment
Ohio	OH	All providers -- participating and nonparticipating	2 years
Oklahoma	OK	All providers -- participating and nonparticipating	2 years
Oregon	OR	All providers -- participating and nonparticipating providers	24 months from the claim denial or payment date, upon written requests (or 30 months if COB issues)
Rhode Island	RI	All providers -- participating and nonparticipating	2 years
Tennessee	TN	All providers -- participating and nonparticipating	18 months
Utah	UT	All providers -- participating and nonparticipating	24 months if the improper payment was due to a coordination of benefits error. 36 months if the improper payment was due to a recovery by Medicaid, Medicare, the Children's Health Insurance program or any other state or federal health care program. 12 months if the improper payment was due to any other reason.
Washington	WA	All listed providers -- participating and nonparticipating, effective 1/1/06	24 months from the claim denial or payment date, upon written requests (or 30 months if COB issues)

State	Abbrv.	Exception Applies To	Time Allowed to File & Pursue a Dispute
Texas	TX	All participating providers and nonparticipating providers who are paid on a participating basis (examples include an emergency situation, a network inadequacy issue, a nonparticipating provider who is pre-approved by Aetna or a hospital-based physician who is a nonparticipating provider but provides services at a participating facility)	4 years for claims and non-claims issues -- (complaints are handled as appeals in TX) TAC 21.2809 A preferred provider that received an underpayment in relation to an audit must notify Aetna within 180 days per Tx law to qualify to receive a penalty for the underpaid amount.