News and Announcements

PROVIDER IMPORTANT  INFORMATION 

Aetna Better Health of Florida will institute a claims exception and expedited authorization process as mandated by the Agency for Health Care Administration (AHCA). These processes apply to covered services provided during and outside the grace period for services provided as a part of pre-storm evacuation and post- storm recovery. The implementation of the expedited authorization process outside of the disaster grace period is also applicable to services such as durable medical equipment, home health services, and early medication refills. The claims exception and expedited process are applicable to participating and non-participating providers. In order for non-participating and participating providers to get reimbursed for services provided during this period the following steps are required:

 

Participating Providers 

  • Services normally not requiring an authorization should be billed following the standard claims submission process, there is no additional information required to process these claims
  • Services requiring prior-authorization will not be denied solely on the basis of not obtaining a prior authorization; in order for an authorization of payment to be provided, providers should submit their request to utilization management.
  • In the request, please provide a point of contact in order to provide expedited authorization information
  • Claims should be submitted through the regular claims submission process once the authorization number is provided; claims submitted without a billing number are subject to delayed processing
  • Services must be covered benefits and appropriate billing and coding requirements continue to be applicable
  • Our claims system requires a billing number and basic provider information in order to pay non- participating provider claims

 

Non-Participating Providers 

  • Services that typically do not require a prior authorization for participating providers will only require notification and formal written request with essential clinical information.
  • The formal credentialing process will be waived for non-participating providers; however, the provider must send the following information as part of the request:

 

 Contact information, Tax Identification Number, NPI Number, Service address, Medicaid number

  • If you have questions regarding what services require prior authorization, please contact our Provider Relations Department at 1-800-441-5501
  • Non-participating providers who are not registered with the state of Florida or out-of-state providers who have provided services to our displaced members during the grace period, should be registered with Medicaid. AHCA has provided instructions on the expedited process for providers to enroll through their portal: http://portal.flmmis.com/flpublic/
  • Providers may also contact our provider relations department for guidance and direction on how to begin the registration process
  • Services that typically require an prior authorization will require the submission of a medical record along with the essential administrative information noted above
  • Once an authorization number is issued the claims must be submitted to the following address:

Aetna Better Health of Florida

PO BOX 63578

Phoenix, AZ 85082-1925 128FL

When applicable, participating and non-participating Providers must submit medical records as described above to the following address:

Aetna Better Health of Florida

Attention: Medicaid Utilization Management Administration Hurricane Dorian Expedited Records

261 N. University Dr

Plantation,  FL 33323