Oon billing aetna timely filing manual#
Oon billing aetna timely filing full#

If the member doesn’t pay, termination of coverage is prospective. Any paid claims with dates of service after termination are subject to overpayment recovery.įor California members: California applies a 30-day grace period. If the member doesn’t pay, their termination date is effective retrospectively to the last day of the prior month that they did pay. You will see “HIX Grace Period” under Plan/Product if the member is in a grace period.įor on-exchange members who don’t receive premium subsidies or off-exchange members: The grace period requirements vary between 30 and 31 days. To determine if a member is in a grace period, log in to Availity to check benefits and eligibility. If the member doesn’t pay their premium and we must terminate them, claims for dates of service in months two and three of the grace period are subject to overpayment recovery. If the member doesn’t pay their premium and we must terminate them, claims for dates of service in months two and three are denied.įor Texas members: Claims are processed during the grace period.

Oon billing aetna timely filing full#

In all states except Texas, at the start of the second month of non-payment, we pend claims until we receive full premium payment. However, the grace period is different between members who receive premium subsidies (Advance Premium Tax Credit) and those who don’t:įor on-exchange members who receive premium subsidies: There is a 90-day premium payment grace period.

That means we’ll continue to pay any claims that occur during the first month of non-payment. To confirm benefits, call your provider support team at 1-88 ( TTY: 711). *FOR DURABLE MEDICAL EQUIPMENT, HOSPITAL AMBULATORY SURGERY, HOSPITAL OUTPATIENT AND RADIOLOGY, PATHOLOGY AND LAB: Some services and equipment may require precertification.

Oon billing aetna timely filing manual#

*FOR DIRECT ACCESS TO SPECIALISTS: Reference our Provider Manual and related materials online to confirm your state’s direct access referral requirements. To find providers in the exchange network, use our online provider search.

Therapy (physical therapy, occupational therapy, speech therapy).Mid-level practitioners (for example, physician assistants, nurse practitioners).

Gynecology care (obstetrician/gynecologist).That’s because members have no out-of-network benefits with any plan, in any state, except for emergencies. The following specialties allow direct access, and may not require referrals:*