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Reclamaciones

You can file claims with us electronically or through the mail. We work to streamline the way we process claims. And improve payment turnaround time, so you can save time and effort. 

 

Questions?

You can check your provider manual (PDF). Or call Provider Experience at 1-855-221-5656 (TTY: 711). You can call Monday through Friday, 8 AM to 5 PM.

Fee schedules and billing codes

 

You can find the billing codes you need for specific services in the fee schedules.

 

Fee schedules

How to file a claim

You’ll need to fill out a claim form. 

 

You must file claims within 180 days from the date you provided services, unless there’s a contractual exception. For inpatient claims, the date of service refers to the member’s discharge date. 

You have 365 days from the date of service to resubmit a revised version of a processed claim.
 

Learn about your options based on your claim type. 

Kansas Medical Assistance Program (KMAP) portal

You can file all claims electronically through Kansas Medical Assistance Program (KMAP). Just log in to the KMAP portal.

Below are your options for filing medical claims (not including dental, vision or nonemergency transportation claims).

 

Electronic 


You can file claims electronically via: 

 

  • Your Provider Portal: You can access a clearinghouse through your Provider Portal. Just log in to your Portal para proveedores to get started. 

  • Office Ally: Use payer ID “128KS.” To register, visit the Office Ally portal and follow the prompts. Nota: Before submitting a claim through your clearinghouse, verify that your clearinghouse is compatible with Office Ally.

  • Change Healthcare (only CMS-1500 claims): You can submit CMS-1500 claims electronically through ConnectCenter using payer ID “128KS” (claim submission) and ABHKS (real time). These come directly to the KanCare (Medicaid) claims system. This is our provider claims submission portal via Change Healthcare (formerly known as Emdeon). To register, visit the ConnectCenter portal and follow the prompts to “Enroll New Customer.”
     

Nota: We cannot accept tertiary claims electronically.
 

By mail


You can also mail hard copy claims to:
 

        Aetna Better Health® of Kansas 

        PO Box 982961

        El Paso, TX 79998-2961

Servicios dentales
 

  • Electronic:

        You can use payer ID “SCION” to submit dental claims electronically through one of these options:

     

    • Por correo en:

          You can also mail hard copy claims to:

       

                        Aetna Better Health of Kansas
                        Claims
                        PO Box 359
                        Milwaukee, WI 53201

 

Nota: The clearinghouses aren’t able to accept and convert paper American Dental Association claims for electronic submission. Your provider office would need to submit the claim data to the clearinghouse from your practice software. Also, SKYGEN’s provider portal supports secondary and tertiary dental claims.


 

Vision
 

  • Electronic:

        You can use payer ID “L0140” to submit vision claims electronically through one of these options:
     

    • Por correo en:

          You can also mail hard copy claims to:
              
              Aetna Better Health of Kansas
              Claims
              PO Box 1607
              Milwaukee, WI 53201

Nota: SKYGEN’s provider portal supports secondary and tertiary vision claims.
 

Transporte

 

  • Electronic: You can submit transportation claims electronically through Access2Care

  • Por correo en:You can also mail hard copy claims to:

                            Access2Care, LLC

                            6363 Fiddler’s Green Circle

                            Suite #1400            

                            Greenwood Village, CO 80111

What is a claim resubmission? 


The purpose of a resubmission is to get a clean claim on file. You have 365 days from the date of service to resubmit a revised version of a processed claim.
 

What is a claim reconsideration?
 

A claim reconsideration is a request that we previously received and processed as a clean claim. The purpose of a claim reconsideration request is to dispute/request review of the processing of a clean claim. A clean claim must be on file prior to submitting a reconsideration request. Providers have 120 days from the date of the Explanation of Benefits (EOB) to file a reconsideration.
 

What is a claim appeal?


Both in-network and out-of-network providers have the right to appeal the result of a decision. You’ll want to file your appeal in writing within 60 calendar days of the reconsideration response (date of EOB).
 

You can check out the flyer to learn more about our claim resubmission, appeals and reconsideration processes.

 

Claim resubmission, appeals and reconsideration information flyer (PDF)

More about appeals

EFT/ERA Registration Services (EERS)

EERS offers our providers a more streamlined way to access payment services. It gives you a standardized method of electronic payment and remittance while also expediting the payee enrollment and verification process. Using the Change Healthcare tool, you can manage electronic funds transfer (EFT) and electronic remittance advice (ERA) enrollments with multiple payers on a single platform.

EFT makes it possible for us to deposit electronic payments directly into your bank account. Some benefits of setting up an EFT include: 

  • Improved payment consistency 

  • Fast, accurate and secure transactions

ERA is an electronic file that contains claim payment and remittance info sent to your office. The benefits of an ERA include:

 

  • Reduced manual posting of claim payment info, which saves you time and money, while improving efficiency  

  • No need for paper Explanation of Benefits (EOB) statements

EERS offers payees multiple ways to set up EFT and ERA in order to receive transactions from multiple payers. If a provider’s tax identification number (TIN) is active in multiple states, a single registration will auto-enroll the payee for multiple payers. You can also complete registration using a national provider identifier (NPI) for payment across multiple accounts.
 

Registering for EERS enrollment
 

If you currently use Change Healthcare as a clearinghouse, you’ll still need to register for EERS enrollment. If you currently have an application pending with Change Healthcare, you won’t need to resubmit. Once you’re enrolled, you can use the Change Healthcare user guide to help you navigate the new system.

To enroll in EERS, you can visit Change Healthcare Payer Enrollment Services.
 

Questions? Just visit the Change Healthcare FAQs page. Or call us at 1-855-221-5656 (TTY: 711).

More information

We conduct two payment cycles a week — Tuesdays and Fridays:

 

  • Tuesdays: Payments (checks and Remittance Advice) from this paid date are mailed Wednesday. EFTs are available beginning Wednesday. 

  • Fridays: Payments (checks and Remittance Advice) from this paid date are mailed Monday. EFTs are available beginning Monday.

Aetna Better Health no realiza ninguna prueba de 837 directamente con sus proveedores, pero sí lo hace con Change Healthcare u Office Ally Inc.

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