aetna medicare advantage timely filing limit 2021

Please find important forms related to the myNEXUS Claims Process listed below.Įlectronic Funds Transfer (EFT) Enrollment: myNEXUS offers EFT payment options for providers. The myNEXUS payer ID for the Aetna delegation is: 34010. This document explains the IV therapy program in detail. Home Infusion (IV) Therapy: IV Therapy Information: myNEXUS is not delegated for IV Therapy. Re-Authorization Request Form:Fax form to use for re-authorization requests if needed.įax Confirmation Form: Online form providers use to confirm their fax numbers for authorization requests Initial Authorization Request Form:Fax form to use for initial authorization requests if needed. The Provider Portal can be found online here. In-Scope Plans: In-Scope Plan List: The list of in-scope Aetna plans for the myNEXUS delegation.Īuthorization Requests: myNEXUS Provider Portal: myNEXUS encourages providers to utilize the online Provider Portal to submit authorization requests. Please complete the “Agency Information Form” to have your agency’s information added to the myNEXUS system.

A recording of a previous session can be found in the myNEXUS Provider Portal or by emailing Information Form: Orientation Sessions: Orientation training sessions have now ended.Notice: The delegation notice and orientation letter mailed and emailed to agencies is available here.Delegated services include Utilization Management, Network Management, and Claims Reimbursement. Delegation: Effective July 1st, 2022, myNEXUS began managing Aetna Medicare Advantage (MA) plans in the states of Pennsylvania and West Virginia.Current Announcements: PA & WV July 1st, 2022 Delegation Information: Please find important announcements, documents, and forms listed below. The Quality Improvement Organization will respond to you as soon as possible, but no later than 14 days after receiving your request for a second review.MyNEXUS is proud to announce its partnership with Aetna to provide utilization management for home health services in Georgia, Kentucky, Missouri, Ohio, Oklahoma, Pennsylvania, Texas, Virginia, and West Virginia. You may ask for this review immediately, but must ask within 60 days after the day the Quality Improvement Organization said no to your Level 1 Appeal. Within 48 hours the reviewers will tell you their decision. If you miss the deadline for contacting the Quality Improvement Organization about your appeal, you can make your appeal directly to us instead. You must contact the Quality Improvement Organization to start your appeal no later than noon of the day after you receive the written notice telling you when we will stop covering your care. You can ask to change this decision so you're able to continue coverage. When your coverage for that care ends, we'll stop paying our share of the cost for your care. You’ll receive a 'Notice of Medicare Non-Coverage (NOMNC)' in writing at least 2 days before we decide it’s time to stop covering your care. (Usually, this means you’re getting treatment for an illness or accident, or you're recovering from a major operation.) Rehabilitation care as an outpatient at a Medicare-approved Comprehensive Outpatient Rehabilitation Facility (CORF).Skilled nursing care as a patient in a skilled nursing facility.You have the right to keep getting your covered services for as long as the care is needed to diagnose and treat your illness or injury if you’re getting:

Aetna medicare advantage timely filing limit 2021