Aetna and Cofinity Updates Lakeland Care Payor Conference Kiley Radel and David Lucas Facility and Professional Contract Negotiator Contacts (respectively)

many options available without login Aetna’s Health Care Professionals website www.aetna.com many options available without login Login thru NaviNet for Aetna Secure Provider portal, link through Aetna.com above or direct. Gives access to Eligibility & Benefits, EOBs, Pre.Certs & Referrals and more. https://navinet.navimedix.com/Main.asp

Aetna Quarterly Newsletter -Quarterly updates. -Signup on Navinet under Communications / Newsletters or www.aetna.com. -National Precertification List. -Clinical Payment, coding and policy changes. -Changes to preferred drug list. -Learning opportunities and more.

Precertification Code Search Tool

Enter Aetna Health Plan Look for Access / Security Officer FAQs and Tips

Contact Aetna Provider Services directly online Example: Select Support Center / Doing Business With Us – see many informational links At Bottom of most screens in Grey Box Under Tools Select “Contact”

Summary of “Contact Us” features NaviNet – Look for a gray shaded “Contact” link in the lower portion of most screens. Benefits of using the  “Contact” feature include: Dedicated staff committed solely to managing requests directed to Aetna through the “Contact” feature. Estimated Turnaround Time for response varies by the complexity of your inquiry but you WILL get a response. Reconsideration option linked through EOBs drives the claim back through the auto-adjudication process, using Contact Us ensures a “person” review. Eliminates the need to contact the Aetna Service Center via phone. You will provide your own direct name, TIN or NPI, email and phone for response. Note***For member type inquires (options 1-5) will need to select Traditional plan (W ID#’s) or HMO for Aetna Medicare, also will need Member ID number and Group number.

You can now attach docs for pended Precerts When requesting a precertification you may need to provide additional information; for example, a medical history record or a radiology report. Now you can attach and send documents from NaviNet. You can attach docs for Precerts with the following statuses only: Pended, Certified in Total, and Certified-Partial. File number and size: You can attach up to 10 documents at a time. Each document must be 16 MB or smaller. File types: You can attach and send the following file types: ·         Microsoft Word (.doc, .docx) ·         Microsoft Excel (.xls, .xlsx) ·         Adobe PDF (.pdf) ·         Images (.gif, .jpg, .jpeg, .png, .tiff) ·         Text (.rtf)  How to Attach Documents To attach and send one or more documents to the health plan: 1.       While viewing a precertification, click Add Attachment.

The Attach Documents window appears: 2 The Attach Documents window appears: 2. In the Attach Documents window, 2 ways to add: a. Click Add Document and then select the doc from a folder on your computer, or b. Click and drag the doc from a folder on your computer to the Drop Documents Here to Attach section. 3. In the Select Document Type dropdown menu, choose a document type for the document. Some document type examples are Progress Report, Laboratory Results, and Radiology Reports. 4. You can add up to 10 documents. If you add the wrong document, point to it, and then click Delete. 5. After you finish adding your doc(s), click Attach to close. Aetna receives your attachments on a daily basis. Once you attach a document, you cannot access or remove it from the precertification. Providers should allow 48 hours after they’ve uploaded their clinical information before checking the status of their precertification request. After 48 hours, providers can submit a Precertification Inquiry transaction or access Precertification Status Updates to see if the status of their precert request changed.

Access Claim payment & coding policies SELECT Support Center / Claims

Access written pricing policies

Alphabetical list

Cofinity Customer Service 1-800-831-1166 Cofinity Website View Cofinity’s updated website at: www.cofinity.net for member & claim inquiry, claim activity reports, access payer information, update provider demographic information and other tools. View the Cofinity website www.Cofinity.net. You will need a sign up for a user id and password. Need a security office for Cofinity website. Who is responsible for verifying access information.

You can also escalate to Cofinity on the website: Go to Cofinity.net / click on a link at the bottom of the page that says “Contact Us” Select Customer Service option There is a dedicated team of people that work that mailbox on a daily basis.

Cofinity platform/Claims migration Starting Jan 1 2019 – Dec. 31 2019 What Does this Mean for Provider? That Claims Workflow will change of where send Cofinity claims. Will be changing to sending Direct to Payers. Payers will send updated ID cards when migrated: updating claim address and payer ID Cofinity Network Reps will be sending monthly updates of payer switches as occur and provider the Payer ID info to Lakeland contacts to be listed on Lakeland Health Provider Website. There will also be updates and communication on Cofinity.net and can call Cofinity Customer Service with any questions or concerns. Cofinity Customer Service 1-800-831-1166

Aetna Better Health Provider Relations: 1-866-314-3784 Contact information www.AETNA.com Aetna Provider Service Aetna Medicare Call Center 1-888-632-3862 1-800-624-0756 https://navinet.navimedix.com Navinet Customer Service 1-888-482-8057 www.COFINITY.net Cofinity Customer Service 1-800-831-1166 Aetna Better Health Aetna Better Health is a separate contract from Aetna Commercial. Please reach out to your direct Aetna Better Health representatives. Aetna Better Health Provider Relations: 1-866-314-3784