Learn more about our clearinghouse vendors here. PLEASE NOTE: The Precertification Request form is for provider use only. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. WEX Health Inc. 2004-2023. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. This means we can connect you to over 700,000 providers , Health WebThe three primary phases of provider credentialing are as follows: 1. Health. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. Aetna Inc. and its affiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Your IP: By using our provider portal on Availity, you can handle tasks for your patients with Aetna plans, including: If youre retiring, moving out of state, or changing provider groups, use this form to notify us. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. An in-network provider belongs to a group of hospitals, doctors, nurses and other health care providers your health plan has contracted with. All rights reserved. However, . Our trusted partnership will afford you and your practice a healthy , https://www.meritain.com/resources-for-providers-meritain-health-provider-portal/, Health (3 days ago) WebAt Meritain Health, we create unrivaled connections. Your benefits plan determines coverage. www.meritain.com . When you select a Meritain Health plan, you get . LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). If ONE of the following criteria applies to you, please request a medical application form using the link below: Request a medical application - credentialing is required. At this time, only PPO , Maryland licensed environmental health specialist, Mesa county health department grand junction, Behavioral health park nicollet st louis park, Missouri department of behavioral health, Community health network medical record, 2019 Healthmoom.com. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Forgot Username? Copyright 2023 Sutter Health. Ready to journey on with us? Prompt claims payment You'll benefit from our commitment to service excellence. Expertise and advanced technologies in all areas of medicine. The AMA is a third party beneficiary to this Agreement. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. Health-mental.org. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. U.S. Patent & Trademark office. What is an in-network provider? We do our best to streamline our processes so you can focus on tending to patients. Alta Bates Summit Medical Center - Alta Bates Campus, Alta Bates Summit Medical Center - Summit Campus, Sutter Maternity & Surgery Center of Santa Cruz. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. This Aetna provider directory includes all Aetna participating providers, including both medical providers and dental providers. At Meritain Health, our goal is simpletake a creative approach to health care and build industry-leading connections. We offer insurance, financial, and, Brooke N. said: This is the best bank that I have ever banked with! No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. We use cookies and limited processing of your personal information for our This page provides an overview of our process: what you need to do and what you can expect , Health WebMetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. by providers with Doctor.com accounts when editing their profile on Doctor.com. We're a proud subsidiary of Aetna and CVS Health . ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Links to various non-Aetna sites are provided for your convenience only. If you have any questions about your benefits or claims, we're happy to help. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. For 24-hour automated phone benefits and claims information, call us at 1.800.566.9311. Cookie Preferences. With Aetna's financial backing and 30-plus years of operational excellence, you can rest assured knowing Meritain Health has the experience and resources to keep your plan. In most cases, the providers office will make a copy of your ID card for your file so they know in advance how to bill you for the service you receive. We also take steps to help you save on the cost of your care. Each main plan type has more than one subtype. The following hospital and/or physician groups accept Meritain Health PPO. Our trusted partnership will afford you and your practice a healthy Detail: Visit URL Category: Health View Health But if youre wondering why to visit doctors in your provider network, you may question how much it actually matters. Chain or Pharmacy Services Administrative Organization (PSAO) pharmacies, Please be sure to add a 1 before your mobile number, ex: 19876543210, Precertification lists and CPT code search, Availity users log in to send us your questions, Submit a medical or behavioral health question or comment, Submit a National Provider Identifier (NPI), Submit a National Provider Identifier (NPI) exemption, Request clinical review criteria for New York state residents, Participating provider precertification list for Aetna (PDF), Non-Medicare plans, including individual and family plans -, Mental health treatment - use phone number on member's ID card, Substance abuse treatment - use phone number on member's ID card, Non-Medicare, including individual and family plan precertification -, Specialty precertification (injectable drugs) for Medicare plans , Specialty precertification (injectable drugs) for non-Medicare, including individual and family plans , Pharmacy precertification (oral drugs) for Medicare plans , Pharmacy precertification (oral drugs) for non-Medicare, including individual and family plans , BRCA genetic testing (precertification and information) -, National Medical Excellence (transplant related care and cellular therapy services) for Medicare, non-Medicare, including individual and family plans , Participating providers can find more precertification phone numbers in, Availity help - registration questions, help with user name/password -, I am a non-physician health care professional who is not employed by an Aetna-contracted provider (physician group, hospital, etc.) Treating providers are solely responsible for medical advice and treatment of members. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. All Time trademark of Sutter Health , Reg. Copyright 2015 by the American Society of Addiction Medicine. Meritain Health is the benefits administrator for more than 2,400 plan sponsors and close to 1.5 million members. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. If you have , https://qa.meritain.com/about-us-self-funded-employee-benefit-plans/meritain-health-provider-services/, Health (5 days ago) WebBecome A Meritain Health Provider Health (4 days ago) WebHealth Care Providers: Join the Aetna Network Health (5 days ago) WebHere's how it works: Step 1. You can learn more by contacting the Customer Service department of your benefits plan. Whether you're building an employee benefits program, researching your member benefits or offering support to your patients, we're ready to help you do more with your health plan. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Prompt claims payment You'll benefit from our commitment to service excellence. Past 24 Hours For 24-hour , Health (6 days ago) WebAddress, phone number, and practice changes For non-participating health care professionals Network applications (behavioral health, dental, facility, and pharmacy) , Health (7 days ago) WebMeritain Health 4 Benefit Highlights Nationwide provider access at a discount When you and your family seek health care services, you have access to Aetnas broad national , Health (5 days ago) WebThe Provider/Specialist who receives the patient referral must submit the completed Specialty Referral form to: Meritain Health, Inc. via fax at (602) 789-9369 or submit via , Health (7 days ago) WebFor member or provider questions regarding benefits, claims status or eligibility call Meritain Health Member Services at 1.800.762.2234 or visit www.MERITAIN.com. And when you have questions, weve got , Health (7 days ago) WebYour online Meritain Health provider portal gives you instant, online access to patient eligibility, claims information, forms and more. Welcome to Meritain Health's Aetna DocFind site. website and services to function. provider's profile, including items like having a photo, a biography, Call-back available NO. Phone number to dial 800-925-2272. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. Treating providers are solely responsible for medical advice and treatment of members. Aaron Lissarrague - American Family Insurance, Our American Family Insurance agency is committed to inspiring and protecting dreams, Welcome to the Roderick Youngdahl agency, serving the Maple Grove, MN area since, **You can drop off the information at Debbie's Tax Facts located in Maple Grove, MN, Becky Meierhofer - State Farm Insurance Agent, Thank you for considering Meierhofer Becky Ins. By showing providers with higher ProfilePoints first, This search will use the five-tier subtype. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. The Meritain Health YouTube channel includes lots of videos with more information about topics our members frequently ask about, and much more! I may or may not be employed by an Aetna-contracted provider. Completing the Application Once you have , https://denmaar.com/aetna-insurance-provider-credentialing/, Healthcare information security certification, Dc department of health and licensing search, Washington state mental health license lookup, Car insurance for healthcare professionals, Ohiohealth physician group primary care, 2021 health-improve.org. Best time to dial 3:45pm. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. Meritain Health P.O. Past Week Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". PROVIDER RELATIONS APPLICABLE STATE Carpenters' Health & Welfare Trust Fund Meritain Health PO Box 853921 Richardson, TX 75085-3921 (87 Web MD/Emdeon, #41124 or McKesson/Relay Health 1761 (314) 644-4802 ext. insurance, payment options, etc. These providers have agreed to discounted rates for the services they offer. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Copyright 2023 Meritain Health. Our trusted partnership will afford you and your practice a healthy dose of advantages. In 2020, we turned around 95.6 percent of claims within 10 business days. Precertification Request. Please note that providers listed in this directory may perform . If youre still not sure which providers are in your network, dont worry! If you do not intend to leave our site, close this message. Have questions about our products, policies and services? If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Privacy Policy Providers cannot request to alter or remove reviews. All rights reserved | Email: [emailprotected], Understanding asian culture in healthcare, How does culture affect health and wellbeing, Home health conditions of participation 2023. We start by getting to know you and your needs, and build a free auto, home or life insurance quote. No fee schedules, basic unit, relative values or related listings are included in CPT. For language services, please call the number on your member ID card and request an operator. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Copyright 2023 Meritain Health. And what if youre not sure how to find one? Customer Number 800-925-2272 - by the Numbers. Gather Information. Were a proud subsidiary of Aetna and CVS Health . Forgot Password? You are now being directed to the CVS Health site. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. When youre caring for a Meritain Health member, were glad to work with you to ensure they receive the very best. Performance & security by Cloudflare. Have other questions about your health care benefits? Click to reveal Email Members: memberservices.mi@mhplan.com Mail Meridian 777 Woodward Ave, Ste 700 Detroit, MI 48226 Meridian Healthy Michigan Phone You can access the online provider portal here. 3. Our phone lines are open 24 hours a day, seven days a week. Call center hours 24 hours, 7 days. All rights reserved. Gwizdala & Associates offers tax, bookkeeping and. After review, Aetna will send your provider agreement via e-mail for signature. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. It is only a partial, general description of plan or program benefits and does not constitute a contract. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. The member's benefit plan determines coverage. Precertification Request Clinical Update Request Welcome to the Meritain Health benefits program. 100% Top 10 Meritain Health Provider Specialties: Ophthalmologist (Eye Doctor) (1 providers) States with the most Meritain Health Doctors: New York Florida Cities with the most Meritain Health Doctors: Fort Lauderdale, FL Smithtown, NY Aggregate Statistics Meritain Health Doctors by Specialty Ophthalmologist (Eye Doctor) 1000 MO IL KS Essence Healthcare Essence Healthcare Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). benefits. The following hospital and/or physician groups accept Meritain Health PPO. Please log in to your secure account to get what you need. While we strive to keep this list up to date, it's always best to check with your health plan to determine the specific details of your coverage, including benefit designs and Sutter provider participation in your provider network. What is Precertification and Why Do I Need It. Others have four tiers, three tiers or two tiers. It is a separate process from network contracting. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. However, if you visit an out-of-network provider, its a little more tricky. This means you could end up having to pay a lot more for your care. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. You are now being directed to CVS Caremark site. Convenient walk-in care clinics for your non-urgent health needs. Meritain Health Doctors nearby with great reviews Zocdoc only allows patients to write reviews if we can verify they have seen the provider. Past month, Health WebMeritain Health is the benefits administrator for more than 2,400 plan sponsors and close to 1.5 million members. Meridian Phone Members: 888-437-0606 (TTY 711) Providers: 888-773-2647 (TTY 711) Meridian's regular business hours are Mon - Friday 8am-6:30pm EST. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. **Please select one of the options at the left to proceed with your request. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. By continuing to use the site, you agree to the use of cookies. Note: If you are a hospital based provider seeking to join an already contracted group, you do not need to complete the application independently. By using our site, you agree to our use of cookies and our, Rheumatologist (Joints & Arthritis Specialist), Physiatrist (Physical Medicine & Rehabilitation), Speech, Language and Hearing Service Providers, Gastroenterologist (Stomach & Bowel Specialist), Pediatrician (Kids / Children Specialist). We take our mission as Advocates for Healthier Living seriouslyand cant wait to support you! Need Help? We are excited to share that MeridianCare, a WellCare company, is , Health (Just Now) WebEnsure that the details you fill in Meritain Benefit Enrollment Form Fillable is up-to-date and correct. Aetna Inc. and its affiliated companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Meritain Health works closely with provider networks, large and small, across the nation. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Credentialing and joining our network - 1-800-353-1232 (TTY: 711). Credentialing involves collecting and , Health WebWelcome to Meritain Health's Aetna DocFind site. Links to various non-Aetna sites are provided for your convenience only. Join CAQH UPD. Meritain Health Provider Enrollment. 437 verified reviews. Provider services Contact us Your patient's health and your ability to access their information is important to us. Health. Contact us at 1.800.925.2272 if you have any questions about your plan. The information you will be accessing is provided by another organization or vendor. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. For serious accidents, injuries and conditions that require immediate medical care. This Aetna provider , https://www.aetna.com/docfind/jsp/rdIndex.jsp?site_id=mymeritain&langpref=en, Health (5 days ago) WebHere's how it works: Step 1. Were a proud subsidiary of Aetna and CVS Health . CPT only copyright 2015 American Medical Association. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. (6 days ago) WebTimely Filing Limit 2023 of all Major Insurances Health (4 days ago) WebThe timely filing limit varies by insurance company and typically ranges from 90 to 180 days. First, you can request participation in the Aetna network by completing our online request for participation form. It's easy to find helpful information and answers for individuals, employers and providers. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Youll be joining a community of like-minded individuals, focused on wellness. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. When you visit the doctor, you may already be a little on edgewithout needing to worry about how your care will be covered! Visit the secure website, available through www.aetna.com, for more information. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Doctor.com has profiles for millions of doctors and other health providers in the United States, including those who take Meritain Health insurance. Next, well evaluate the , https://www.aetna.com/health-care-professionals/join-the-aetna-network.html, Health (Just Now) WebNetwork Participation and Credentialing Thank you for your interest in becoming a participating provider in AmeriHealths provider networks. Links to various non-Aetna sites are provided for your convenience only. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Please fill in all fields. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Call picked up by a real person YES. Aetna Inc. and itsitsaffiliated companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Find a Northern Californian Provider that meets your needs. The Provider/Specialist who receives the patient referral must submit the completed Specialty Referral form to: Meritain Health, Inc. via fax at (602) 789-9369 or submit via email at group_precert-referrals@meritain.com in order for claims to be paid. All rights reserved | Email: [emailprotected], Healthcare information security certification, Dc department of health and licensing search, Washington state mental health license lookup, Car insurance for healthcare professionals. New and revised codes are added to the CPBs as they are updated. An in-network provider belongs to a group of hospitals, doctors, nurses and other health care providers your health plan has contracted with. CPT is a registered trademark of the American Medical Association. Meritain Health is the benefits administrator for more than 2,400 plan sponsors and close to 1.5 million members. 69.163.152.136 " This site has been specially designed to provide quick and easy access to the Aetna provider directory. CPT only Copyright 2022 American Medical Association. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. This site has been specially designed to provide quick and easy access to the Aetna provider directory. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Our trusted partnership will afford you and your practice a healthy dose of advantages. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. After-hours, weekend and holiday services. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Select the Sign icon and , Health (4 days ago) WebHealth Care Providers: Join the Aetna Network. 10.0 miles away from Meritain Health Our American Family Insurance agency is committed to inspiring and protecting dreams in Edina, MN. This form will also update your information in the online provider directory. At Meritain Health, we create unrivaled connections. The Aetna Service Centers help with benefits, claims, appeals, contracted rates, and many other questions. Step 2. Powered by WEX Health 4.75. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. The ABA Medical Necessity Guidedoes not constitute medical advice. Username. Thank you for your interest in joining our networks. The CAQH registration process prevents providers from submitting the same information to . For Providers Meritain Health Provider Portal Meritain Health WebMeritain Health is the benefits administrator for more than 2,400 plan sponsors and close to 1.5 million members. Meritain Health Member Services - Meritain Health Member services Contact us Your health and your ability to access your information is important to us. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information.