Services and Tools for Medical Professionals
Transactions
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Doing Business with Aetna
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Clinical Resources
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Pharmacy
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Forms
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State Specific Variations
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Aetna Voice Advantage - 24/7 Access to Information
Physicians may use the self-service Aetna Voice Advantage system for a variety of
administrative needs such as:
- Checking claim status,
- Checking coverage and benefits,
- Obtaining a claim mailing address,
- Checking on multiple patients participating in different Aetna plans, and
- Attaining useful Aetna web site addresses, toll-free numbers, etc.
With Aetna Voice Advantage, you may call and hear your patient’s effective or termination
date, type of product (HMO, PPO,
etc.) and type of coverage (employee only, family, etc.). To provide even more
convenience, detailed benefits information for
the most frequently requested service types is available by using simple standard office
language or American National
Standards Institute (ANSI) standards. For instance, you could say “diagnostic medical” or
(ANSI standard) “73,” and the
system would recognize your request and provide the applicable benefit details (copayment,
deductible, etc.) by phone or fax.
If you opt for fax back, we will attempt to reach your fax number several times within 10
minutes of your call.
The system is up and running. We encourage you and your staff to access this new
technology. Aetna customer service
professionals also are available during regular business hours to answer your questions.
You can access Aetna Voice Advantage
by calling any of our 1-800 customer service numbers.
You will be receiving detailed information about Aetna Voice Advantage soon. Feel free
to contact us via e-mail
with any questions.
DocFind® for
Physicians
DocFind for
Physicians is the online provider
directory available to Aetna participating providers. This searchable, online directory
lists physicians, hospitals and other
health care professionals participating in Aetna's networks, along with their PINs. It has
been specifically formatted to
make it more easily used by physicians in the referral process. Because DocFind is
refreshed three times each week, it
provides the most up-to-date information available on participating providers.
We also invite you to check your own listing in DocFind for Physicians to ensure that the
information that we are presenting
to members about you is accurate. If any of this information is incorrect,
send us corrections.
Please include your full name,
PIN number and zip code to allow us to identify you and update your file.
Educate Your Patients About a Resource Available for Healthier
Hearts
It's time to change the way patients access health information on the Internet. That's why
Simple Steps To A Healthier
Heart™, a new online resource, puts the physician-patient relationship at the
forefront. It's not just another
consumer-health website; it's an innovative, online patient education library at the
disposal of physicians and patients 24
hours a day, 7 days a week.
The Simple Steps To A Healthier Heart program provides decision-support, behavior
modification and educational tools to help
consumers make more informed health-care choices. The program offers easy-to-understand,
authoritative medical content,
which is reviewed by a team of some of America's leading physicians.
What are the features of the Simple Steps To A Healthier Heart program?
- Patient education handouts
- A 24-hour patient education library
- Colorful animated illustrations designed to make complex concepts clear for patients
- Disease management tools
- Innovative programs to encourage health-promoting behaviors
- Procedures and diagnoses searchable by CPT and ICD codes
What are the benefits to the physician of the Simple Steps To A Healthier Heart program?
- Access to the program through the physician's own practice website
- The ability to prescribe reliable condition-specific educational materials to patients
- A time-saving approach to patient education
- Enhanced patient relationships
- Increased practice efficiency and quality of care
To register, or learn more about the Simple Steps To A Healthier Heart program, please
visit: http://www
.simplestepsheart.com/register.
Credentialing and Becoming an Aetna Physician
Credentialing is a systematic approach to collection and verification of a practitioner
applicant's professional
qualifications, such as relevant training, licensure, certification, and/or registration
to practice in a healthcare field,
and academic background, as well as an assessment of whether the practitioner meets
certain criteria relating to professional
competence and conduct. The Aetna credentialing process evaluates the qualifications of
practitioners who provide care to
Aetna members. This process is completed before a practitioner is accepted for
participation in an Aetna network.
Click here to learn more about Aetna's credentialing
process, how you can apply to become an
Aetna provider, and Aetna's affiliation with CAQH.
Aetna Clean Claim Disclosure for Texas-Based Physicians and Health Care
Professionals
The following information describes Aetna's clean claim policies and required elements
under SB 418:
Texas Clean Claim Elements under SB
418
California HMO Member Rights & Responsibilities - Complaint & Appeal
Procedures
Complaint & Appeal Procedures:
California HMO Member Complaint/Appeal Form:
This form is for Aetna members' use. Your office may print this form and give it to
your patient upon request.
Instructions to the member are included on the form.
Arizona Definitions and Requirements for Provider Grievances
For information pertaining to the State of Arizona's definitions and requirements for
provider grievances, please see:
New Jersey Department of Banking and Insurance Health Care Provider Application to Appeal a Claim Determination
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