FAQs

Provider portal questions

Provider Portal

Administrator and login questions

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.

Yes, except for the First Health Network (TPA/Carrier) business.

Yes. Multiple staff can be set up for each Tax ID.

No, one user ID and password gets you access to all Aetna Better Health plans.

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.

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.

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.

Two hours.

No. However, administrators can reset passwords as needed.

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.

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.

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

Three years, depending on the plan.

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.

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.

The Patient Control Number is the medical record number we receive from the provider associated with the claim.

"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.

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”.

Claims submission will be available in a future release.   

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.

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.

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. 

Mailing address for paper claims:

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

Eligibility/benefits questions

Yes, dependent information will appear in eligibility. A dependent’s detail can be found by clicking on the dependent.

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.

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.

 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.

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.

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.

Yes.

Remittance advice questions

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.

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.

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.

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.

Other questions

We typically respond within 2-3 business days. However, we allow ourselves up to 30 days to respond to electronic inquiries.

This is not currently available via the Provider Portal. It will possibly be available in future enhancements. For mor information on the status of your credentialing application, contact Provider Relations.

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.

Yes. The search function allows you to search the Resource Library using any terms you wish.  Searches are done through the titles and the body of the documents online.

Yes. Forms can be found in the Resource Library.

Yes. Provider inquiries can be sent to FL Provider Relations. All claims questions can be resolved by contacting us at 1-800-441-5501(Medicaid), 1-844-645-7371(Long Term Care) and 1-844-528-5815(Florida Healthy Kids).

Only current member ID cards are available in the provider portal. If you cannot find a member ID card online, please call the health plan at 1-800-441-5501 (Medicaid), 1-844-645-7371 (Long Term Care) and 1-844-528-5815(Florida Healthy Kids).