FAQs

Provider portal questions

How do I learn more about the provider portal?

There are several options for learning about provider portal. We encourage providers who are using this online service to learn as much as they can so they can take advantage of all the online services available to them. Training includes:

Detailed Users’ Guide – This can be found in the help section after you have logged in or in the Resource Library.
Help screens – Be sure to take advantage of the help sections within the provider portal as they provide additional insights into the program.
Online Webcast training – Aetna Better Health corporate training routinely conducts online group training for this service and for new functions as they are released. Check on our website or call your Provider Relations Representative for more information. This is an excellent way to learn the tool and find out what questions other providers are asking.

Administrator and login questions

We are very large and have multiple tax IDs and dozens of provider IDs. How do we set these up?: The provider portal is flexible enough to meet your needs. You have the option of determining if you want to have one administrator who set up all users, or several administrators at different sites. If you are a billing office/service, you will be required to get permission to access data associated with a tax ID you do not own. Registration/setup instructions walk you through step by step during the process.
Are all Aetna Better Health plans available?: Yes, except for the First Health Network (TPA/Carrier) business.
Can you have separate administrators for the same Tax ID?: Yes. Multiple staff can be set up for each Tax ID.
Will I need separate passwords to view the different health plans?: No, one user ID and password gets you access to all Aetna Better Health plans.
What is the provider number and where do I get it?: The provider number is a unique number that is assigned to you by your health plan. It can be found in the upper left corner of your Aetna Better Health Remittance Advice, or you can request this number from your Provider Relations Representative.
We are a non-participating facility and do not contract with a Aetna Better Health plan. Can we get access to the Provider Portal?: Yes. If you have ever filed a claim with any Aetna Better Health Plan, you will have a provider ID number. There is no cost even if you are not contracted with one of the Aetna Better Health plans. You can register under any Aetna Better Health provider ID, and then add additional or new Aetna Better Health Plans later.
How do I select providers for another health plan?: In the box where the Provider drop down menu appears is an Edit button. Click the Edit button. From the Provider Edit/Customization screen, you can customize each Tax ID for each health plan. Be sure to click Done when you are finished making your selections.
How long is the time out before the system logs you out for no activity?: Two hours.
Will passwords expire?: No. However, administrators can reset passwords as needed.
Is “Provider” defined as the practice or the Tax ID?: There is a Tax ID for the overall group, but each provider can be looked at separately. All Provider ID numbers we have associated with each Tax ID are available.
One of the physicians is no longer with the practice and is still appearing in the drop down. How do I fix this?: Take some time to remove the physicians that you do not want appearing in the drop down menu by using the Edit function in the Provider drop down area of the portal. Customizing this list is the easiest way to weed out unwanted physician records from the list. All providers we have had associated with a Tax ID can be viewed in the event you wish to look up historical information. If you see information that you believe to be incorrect, please contact your Provider Relations Representative.

Medicaid Provider Relations at 1-800-441-5501
Long Term Care Provider Relations at 1-844-645-7371
Florida Healthy Kids Provider Relations at 1-844-528-5815

You can also just send us an email.
I have an issue for an inactive user, post Tax ID addition. The user tried to log on and they received an error.: The administrator needs to add the Tax IDs to any users who did not activate their account. The user is locked out until the administrator adds them to the Tax ID.

Claims questions

How much claim history is available online?: Three years, depending on the plan.
What Medicaid plan information are you able to see?: Claim Inquiry information includes claim summary, history, and detail, just as it appears for commercial plans. Member Eligibility information includes coverage history, PCP history and COB information, if available. Remittance advices are available. However, benefit information is not available for Medicaid members.
How are offsets and backouts shown on the claims status?: Backout claims (these claims have a negative balance) are associated with a specific claim and are only available by clicking or searching on the original claim associated with the backout. Claim Detail gives you the option to see the original claim, backout claim, and/or replacement claim. The claim type is identified at the top of the claim.
What is the Patient Control Number?: The Patient Control Number is the medical record number we receive from the provider associated with the claim.
I currently see "Unpaid Claims" in addition to other statuses. Is this OK?: "Unpaid Claims" is not a claims status. It is a search option which shows all claims that do not yet have a check or EFT payment associated with it. Keep in mind that an approved status may eventually get denied or pended; it is not a guarantee of payment.
Do claims include the rejected claims from our clearinghouse, or where they are rejected from?: No, you will not be able to see claims rejected at the clearinghouse, since we would not have received them. The rejected claims you can view online are ones that are rejected by Aetna Better Health, after they passed through the clearinghouse. If you submitted your claim directly to us, without going through a clearinghouse, then they will all appear. An example of a rejection is “patient not found”.
Can I submit claims directly through the provider portal?: Claims submission will be available in a future release.
Why do some claims allow you to view the remittance advice and others do not?: It depends on who the claim was paid to. If you are viewing a claim under a provider ID that did not receive payment for that claim, then the remittance advice link will not appear with that claim. To view the remittance advice, look up the remittance advice under the appropriate provider ID it was paid to.
Can claim adjustments be requested online?: Yes. This service allows a provider to request that the plan take another look at a claim based on additional information, including attachments that can be sent via the provider portal. However, it is not a formal appeal.
I submitted a claim to the health plan. It was paid, but I cannot find it now.: Aetna Better Health internally routes claims to the correct payer, even if the claim was submitted to the incorrect health plan. If you submitted the claim to the incorrect Aetna Better Health Payor ID and it cannot be found, you should check under another Aetna Better Health plan you do business with. Also, review your remittance advice for any information on the re-routed claim.
Where do I mail my paper claims ?: Mailing address for paper claims:

Aetna Better Health of Florida
Attn: Claims
P.O. Box 63578
Phoenix, AZ 85082-1925

Eligibility/benefits questions

If you put in a subscriber, will you see the dependents?: Yes, dependent information will appear in eligibility. A dependent’s detail can be found by clicking on the dependent.
Will the provider portal have an avenue for optometric practices to get eligibility information such as last eye exam, last frame, last lenses, and so on?: It depends on whether the benefit is a carve-out or not. If the coverage category is a carve-out, the response will request that you call Member Services. Since it is not the same for all products or plans, availability of this benefit information will be hit or miss.
Can I authorize a patient to be able to choose one of our physicians as a PCP if we now have a closed panel?: No, members are the only ones that can change their PCP. Providers do not have the ability to do so, nor is there anywhere they can identify themselves as an open or closed panel for just one patient.
Is there a "general" coverage category to simply view overall eligibility rather than having to look under each coverage category?: Yes. There is a default coverage category called “general eligibility”. However, for any coverage category, the response will contain overall eligibility at the top of the screen. Note that the Help section provides clear information on how to read benefits online.
"Customize your categories" – what is that for, and why would I need it when the general eligibility displays at the top of every page?: Using a specific coverage category would allow you to view benefit limits and guidelines for that specific benefit type. For example, you could get a copay specific to infertility testing.
Can I narrow the coverage category drop down list? It contains information I won’t ever look at?: Yes, you can edit the list and remove those categories that you do not plan to use by clicking “Customize Your Coverage Categories” below the coverage category field.
Is the PCP History function available in for a newly termed member?: Yes.

Remittance advice questions

We are not able to receive electronic remittance advices (ERAs) but want electronic funds transfer payments (EFTs). Can I pull in remittance advices (RAs) without patient information?: Yes, there are several ways to look up ERAs, including service dates, payment dates, or payment number (EFT, check number). You will also find a link directly to an ERA when viewing a paid claim.
Can I stop receiving paper remittance advices since I can now obtain them online?: Yes, simply notify your Provider Relations Representative and they can stop paper remittances from arriving in the mail.

Medicaid Provider Relations at 1-800-441-5501
Long Term Care Provider Relations at 1-844-645-7371
Florida Healthy Kids Provider Relations at 1-844-528-5815

You can also just send us an email.
I searched for an ERA using a specific doctor’s name and could not find it.: You must search for remittances using the provider number who received payment for that claim. If the claim is paid to the vendor, search using that provider number. If the claim is paid to the master vendor, search using that provider number.
How long does it take for the ERA to be available online?: The ERA will be available online 24 hours after the check/EFT is created. There are limited occasions where the health plan can hold up a remittance advice for more than 24 hours.