Tag: #Aetnamedicareadvantage

Posted in Insurance, Training, Updates

Aetna new prior authorization fax# for NJ FIDE DSNP providers

Posted on by KR2Medical Billing

What is NJ FIDE DSNP program? (short definition)

New Jersey has a Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) Program that is available for individuals who have both Medicare and Medicaid benefits. A FIDE SNP is a special kind of Medicare Advantage plan that combines all of the services offered by original Medicare and a prescription drug plan, along with all of NJ FamilyCare’s managed care services.

This program is available through several insurance carriers, including AETNA – Aetna Assure Premier Plus (HMO D-SNP).

IF you are a provider located in NJ and accept FIDE DSNP members, effective 01/01/2021 all prior authorization requests and clinical information requests for Aetna Assure Premier Plus (HMO D-SNP) members should be faxed to a new fax: 1 833-322-0034.

If you have any further questions, please call Provider services: 1-844-362-0934 Monday through Friday 8am to 5pm EST.

Posted in Insurance, My services, Training, Updates

Aetna: New Medicare Advantage Plans in North Carolina, South Carolina and Tennessee- 01/01/2021

Posted on by KR2Medical Billing

As of 01/01/2021- there are 2 new HMO plans that will be available in NC, SC and Tennessee: These plans are Aetna Medicare ValueSM Plan (HMO) and Aetna Medicare Value Plus Plan (HMO)

These plans will require to choose a PCP. However, they will NOT require a referral to see a specialist. This information will be on the member cards, as indicated by the red arrow below:

The following is the list of the plan types:

Supplemental Benefits: NOT all plans will have these available

  • Dental (preventive and comprehensive)
  • Over-the-counter (OTC)
  • Hearing Aids
  • Post hospital discharge meal delivery
  • Telehealth

Additional Information:

  • All members must select a primary care physician.
  • There is no referral requirement for specialty care.
  • Participating providers can submit pre-authorization requests through our provider portal, or they can also fax the request or call it in to the Provider Service Center.
  • These plans include pharmacy Part D coverage.

Note: No out-of-network benefits exist for these plans unless the member follows the approval process. They can start this process by contacting Member Services directly.