At a glance - Aetna

1 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions A quick reference guide for health care professionals Aetna at a glance F (4/18). A guide for doing business with Aetna Communications 2 Communications Sign up to receive electronic communications from Aetna , Our website 3 including OfficeLink UpdatesTM, our provider newsletter. It is published quarterly March 1, June 1, September 1 and December 1. This newsletter can include changes to policies Aetna Support Center 3 that may have an impact on your practice or facility.

2 Log in to our provider website and select Aetna Health Plan . Tools and transactions 4 from the workflow menu. Choose Email Options, then Share Email Address. Enter your email address and review Claims information 5 the Email Acknowledgement. Note: OfficeLink Updates is only available by email or through Contact information 6 the Health Care Professionals section of , unless you have a specific need (for example, your office does not have Internet access). In Laboratory information 6. these instances, you will have the option to receive a printed version upon request .

3 Provider webinars 7. Northeast Region 8. Mid-America Region 10. Southeast Region 12. West Region 14. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates ( Aetna ). 2. Our website Resources You can reduce the amount of time you spend on For your convenience, a list of the most commonly used tools administrative tasks by using Aetna 's provider website. You'll and resources is available for quick access upon logging in to have access to the information you need when you need it.

4 Our site. To access our website, go to and click precertification Code Search Tool Log In/Register, then under Medical Professionals, choose Aetna 's Clinical Policy Bulletins (CPBs) are detailed and Log In or Register. technical documents that explain how we make coverage decisions for members under our health benefits plans For successful registration, you will need: Tax identification number (TIN) Aetna Support Center Physician name, group name or hospital name Clinical resources Email address Aetna Health ConnectionsSM disease management Primary office location programs, which provide educational materials and, in some When interacting with Aetna online, you'll be using NaviNet , cases, individualized case management for members with a free, multipayer, web-based system for administrative chronic health conditions.

5 The programs focus on health transactions. You can use the available tools and resources education and behavior modification for modifiable risks. to access information quickly without having to pick up the Aetna Women's HealthSM programs and policies provide phone. detailed information about Aetna 's gynecologic and Website security officer obstetric programs and policies. This includes information on our maternity program, infertility program, BRCA. Upon registration, it will be necessary to designate a NaviNet Genetic Testing Program, Obstetric Ultrasound security officer for your office.

6 The security officer will act as Enhancement Program and Non-Stress Test Enhancement the primary contact with NaviNet and will also monitor and Program. assist the NaviNet users in your office. To learn more about the security officer role, visit Doing business with Aetna If some of the tools in NaviNet can't be seen, please contact Aetna Benefits Products an easy-to-use guide that your security officer for access. There are some transactions provides basic Aetna benefits product information, that must be enabled by the security officer.

7 Including primary care physician (PCP) selection and referral requirements. Need help? Office Manual for Health Care Professionals your For registration questions or log-in/password assistance, guide to working with Aetna . This reference tool acts as our call 1-888-482-8057, Monday Friday, 8 11 ET, provider manual, including local information that pertains and Saturday, 8 3 ET, closed Sunday. to your practice. Our Member Rights and Responsibilities are NaviNet offers several helpful online support tools: also included in the manual.

8 On-screen help to walk you through each step of a Forms Library transaction Electronic remittance advice (ERA)/electronic funds transfer Step-by-step transactional and Aetna user guides (EFT) enrollment forms Online training demonstrations BRCA prior authorization forms Lab selection forms Important announcements Member health information forms/charting aids This area on the Aetna Plan Central home page is used to communicate time-sensitive information that may affect Pharmacy how you do business with Aetna .

9 Formulary information Pharmacy Clinical Policy Bulletins Aetna Specialty Pharmacy program e-Prescribing 3. Tools and transactions - Policy Information to find policy-related links if you are searching for general information on a topic or if you do Eligibility not have a specific procedure code Use the Eligibility and Benefits inquiry to obtain member- specific plan details. Transaction response fields include Claim EOB Tool (field may vary according to plan details): This tool allows providers and office staff to access claim Copay, deductible and coinsurance Explanation of Benefits (EOB) statements online within 24 hours of claims processing.

10 You may also use this tool for Exclusions and limitations claims reconsiderations. There are multiple ways to search Visits used and visits remaining for an EOB using this tool: Referral and precertification requirements Access a daily list of EOBs Ability to view and print digital member ID cards*. Search by a claim Tips when completing the Eligibility and Benefits inquiry: Search by an individual patient You may search using the patient's last name, first name Search by a payment (includes EFT trace number, check and date of birth if you don't have the member ID number number or dollar amount).