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How do I ask for a Medicare appeal with Aetna?

You can file a grievance or appeal using our online grievance and appeal form. 1-855-772-9076 (TTY: 711). You can send a secure fax to Aetna® grievances and appeals at 959-888-4487. Your doctor can file a grievance or request an appeal on your behalf after you give them your written permission.

What is the timely filing limit for Aetna?

We've changed the standard nonparticipating-provider timely filing limit from 27 months to 12 months for traditional medical claims. The updated limit will: Start on January 1, 2022.

What is Utilization Review?

Utilization review (UR) is the process of reviewing an episode of care. The review confirms that the insurance company will provide appropriate financial coverage for medical services. The UR process and the UR nurse facilitate minimizing costs.

What is a retrospective review in healthcare?

What is retrospective review? Retrospective review is the process of determining coverage after treatment has been given. These evaluations occur by: Confirming member eligibility and the availability of benefits. Analyzing patient care data to support the coverage determination process.

How long does it take for Aetna to respond to an appeal?

Timeframes for reconsiderations and appeals Dispute levelDoctor / provider submission timelineAetna response timeframeAppealsWithin 60 calendar days of the previous decision.*Within 60 business days of receiving the request. If additional information is needed, within 60 calendar days of receiving that information.1 more row

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Does Aetna do retro authorizations?

Retrospective review is available when: Precertification/notification requirements were met at the time the service was provided, but the dates of service do not match the submitted claim.

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