How do you submit Aetna appeal forms?


Quick Answer

As of January 2016, health care providers may mail Aetna appeal forms to the Aetna Provider Resolution Team using the appropriate P.O. box address, depending on the state of residence, instructs the Aetna website. There are two P.O. box locations, one in Lexington, Kentucky, and the other in El Paso, Texas. Information on which address that providers in different states should use is available on the Disputes & Appeals Overview page, located under the Health Care Professionals section of Aetna.com.

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Full Answer

To review a submitted appeal, Aetna requires a copy of the denial letter or Explanation of Benefits form, the original claim, an explanation of why the provider feels the company's decision is wrong, and documentation supporting the provider's position, states the company website.

The steps for reviewing disputes and appeals are reconsiderations, level one appeals and level two appeals, notes Aetna. During the reconsideration phase, the company formally reviews coding decisions, unprocessed claims and claim reimbursements. A provider must submit an appeal for reconsideration within 180 days of the original claim decision.

Providers may submit a level one appeal if they disagree with a reconsideration decision, explains Aetna. If they disagree with the level one appeal decision, they may then submit a level two appeal. The provider must submit level one or two appeals within 60 days of the previous decision they are appealing. Aetna responds to level one and two appeals within 60 days of receiving them. If the company requests additional information, it responds within 60 days of receiving the further information.

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