Medicare resources for providers
We’re here to help you stay compliant with Medicare regulations. Find information about Aetna® Medicare Advantage plans, compliance training, attestation requirements and more.
We comply with privacy laws during HEDIS data collection
The U.S. Department of Health and Human Services (HHS) confirms that providers may share protected health information (PHI) with health plans for quality-related health care operations without a patient waiver.
Our data collection efforts comply with the Health Insurance Portability and Accountability Act (HIPAA). All information is private, and we only use data in an aggregate form. We don’t release patient-specific information, so we don’t need the patient’s signature.
To learn more about the HIPPA privacy rule, go to the U.S. Department of Health and Human Services.
Aetna Medicare Advantage plans include any of the following:
Aetna Medicare Advantage (MA) plans include HMO, PPO and SNP (Special Needs Plans) benefits to Medicare-qualified members. Aetna offers Dual Special Needs Plans (D-SNPs) to members who also receive Medicaid benefits and/or assistance with Medicare premiums or Parts A & B cost-sharing and live in a county where Aetna Medicare offers a D-SNP. D-SNPs include any of the following:
- Dual Eligible Special Needs Plans (D-SNPs)
- Highly Integrated Dual Special Needs Plans (HIDE-SNPs)
- Fully Integrated Special Needs Plans (FIDE-SNPs)
The Aetna Medicare-Medicaid plan (MMP) isn't a Medicare Advantage plan. The MMP is a plan that provides coordinated Medicare and Medicaid benefits for dually eligible individuals.
Aetna Medicare Advantage quick reference guide (PDF)
Get to know Aetna Extended Service Area (ESA) Plans
Get to know Aetna Extended Service Area (ESA) Plans
New to ESA plans or just want to learn more? We’re here to help. In this video, you’ll learn what these plans cover, tips to check patient eligibility and how billing works. You’ll also find contact info if you need help along the way.
Background music: Light guitar instrumentals play in background during the entire video.
Narration: Aetna Extended Service Area plans and you.
On-screen text: Aetna Extended Service Area (ESA) Plans and You
Media description (scene 1): Medical appointment with two Medicare patients speaking to a health care provider.
Narration: Not sure what an Extended Service Area plan is? You’re not alone. They are also known as ESA plans and can sometimes be confusing to both providers and members. And you may have a patient in your practice who is a member of one of these unique and versatile Aetna Medicare Advantage PPO plans. Members not only have access to in-network providers, but they can receive services from out-of-network providers at no additional cost to them.
On-screen text: What is an Extended Service Area (ESA) plan?
- Access to both in-network and out of network providers
- No additional cost to your patients
Media description (scene 2): Health care provider writing a treatment plan.
Narration: This plan design provides our members access to any provider who accepts Medicare assignment and agrees to bill Aetna. Over 80 percent of Aetna Group members have an ESA plan.
On-screen text: Access to any provider who accepts Medicare assignment and agrees to bill Aetna
Media Description (scene 3): Nurse explaining therapy to a Medicare member during a home visit.
Narration: To verify your patient’s benefits and coverage, simply confirm on your eligibility portal such as Availity or by contacting Aetna's provider services team at 1-800-624-0756 ${tty}, Monday through Friday, 8AM to 5PM local time.
On-screen text: Verifying patient benefits and coverage
Review the patient's benefits on your eligibility portal such as Availity
Contact Aetna’s Provider Services team at 1-800-624-0756, Monday–Friday, 8 AM–5 PM local time
Media description (scene 4): Doctor working with documents.
Narration: We’re here to make things more seamless for our members and their providers. With ESA plans, there are no referrals or precertification required, however precertification is recommended to reduce the chance of denials.
On-screen text: No referrals required. Precertification is not required for most services but recommended.
Media description (scene 5): Office staff member reviews documents carefully.
Narration: Billing is also simplified. Start by collecting the member’s copayment for covered services during the visit. Make sure to include the patient’s paid amount when submitting a claim. You’ll only have to submit one bill to Aetna. Please note that balance billing patients is not permitted according to CMS guidelines.
On-screen text: Billing simplified.
- Collect member copayment.
- Include patient paid amount.
- Submit one bill to Aetna.
Media description (scene 6): A desk with a stethoscope and medication history record form. A doctor is working on a laptop computer in the background.
Narration: Reimbursement is easy, too. You’ll receive your payment within 6 to 8 weeks of submission. The Medicare fee schedule and Medicare limiting charges will apply. If you already participate with Aetna, the terms of your agreement apply. But, if you don't, no contract is required to see patients enrolled in an ESA plan. It’s just that simple!
On-screen text: Provider Reimbursement
- Payment within 6-8 weeks
- Medicare fee schedule and limiting charges apply
- No contract required
Media description (scene 7): Health care professional discusses medical information with a Medicare patient.
Narration: We’re here to help. For more information on billing and payment, visit the website on the screen or give us a call at 1-800-624-0756 ${tty}, Monday through Friday, 8AM to 5PM local time, to speak with our provider services team if you have questions.
On-screen text: For more information on billing and payment.
Visit aet.na/claims or call 1-800-624-0756 Monday–Friday, 8 AM–5 PM
Media description (scene 8): Doctor talks to a Medicare patient in a hospital.
Narration: Together we can improve the health of our community. Healthier happens together. Thanks for watching.
On-screen text: Healthier happens together®
Media description (scene 9): Doctor and patient smile and give each other a high five in front of a tablet.
Annual Medicare compliance program requirements
All providers who participate in our Medicare Advantage plans need to meet the Centers for Medicare & Medicaid Services (CMS) compliance program requirements for first-tier, downstream and related entities (FDR). We complete random audits to help make sure you’re compliant.
Step 1: Complete training
For all Medicare providers/delegates, for all plan types: Review Aetna FDR Medicare compliance guide (PDF).
For all providers/delegates treating SNP members: Review SNP Model of Care/MOC training (PDF).
Step 2: Complete attestation: Due by October 31
After you’ve reviewed the required compliance and training, complete your attestation. You need to do this every year. You’ll get credit for the year in which you complete it.
Important: We can’t accept paper, downloaded, faxed or mailed attestations. To get credit, you need to sign the attestation electronically using one of these links:
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MA and/or MMP plans |
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MA and SNP plans |
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Delegated entities: MA and/or MMP plans |
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Delegated entities: MA and SNP |
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MA and/or MMP plans |
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Attestation requirements |
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Medicare plan(s) |
MA and SNP plans |
Attestation requirements |
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Medicare plan(s) |
Delegated entities: MA and/or MMP plans |
Attestation requirements |
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Medicare plan(s) |
Delegated entities: MA and SNP |
Attestation requirements |
Be on the lookout for Medicare compliance updates
We’ll keep you informed about annual compliance requirements through Adobe Acrobat Sign email or postcard. You can also browse our OfficeLink Updates library for news throughout the year.
Additional resources
2024 FDR newsletters
More Medicare resources for you
Legal notices
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).
Health benefits and health insurance plans contain exclusions and limitations.