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Claims

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. 

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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.

You have a few options for filing medical claims based on medical claim type (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 Provider Portal to get started. 

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

Note: 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

Dental
 

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

     

    • Availity: Log in or register at Availity

  • By mail: You can also mail hard copy claims to:

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

Note: 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:
     

  • By mail: You can also mail hard copy claims to:

    Aetna Better Health of Kansas
    Claims
    PO Box 1607
    Milwaukee, WI 53201

 

Transportation

 

  • Electronic: You can submit transportation claims electronically through Access2Care. 

  • By mail: You can also mail hard copy claims to:

    Access2Care, LLC
    6363 Fiddler’s Green Circle
    Suite #1400
    Greenwood Village, CO 8011

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. 

 

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.  

ECHO Health processes and distributes claims payments to providers. To enroll in EERS, visit the Aetna Better Health ECHO portal. You can manage electronic funds transfer (EFT) and electronic remittance advice (ERA) enrollments with multiple payers on a single platform.

 

Sign up for EFT

 

To sign up for EFT, you’ll need to provide an ECHO payment draft number and payment amount for security reasons as part of the enrollment authentication. Find the ECHO draft number on all provider Explanation of Provider Payments (EPP), typically above your first claim on the EPP. Haven’t received a payment from ECHO before? You’ll receive a paper check with a draft number you can use to register after receiving your first payment.

 

Update your payment or ERA distribution preferences

 

You can update your preferences on the dedicated Aetna Better Health ECHO portal. 

 

Use our portal to avoid fees

 

Fees apply when you choose to enroll in ECHO’s ACH all payer program. Be sure to use the Aetna Better Health ECHO portal for no-fee processing. You can confirm you’re on our portal when you see “Aetna Better Health” at the top left of the page.

 

Be aware — you may see a 48-hour delay between the time you receive a payment, and an ERA is available.

More information

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

 

  • Tuesdays: Payments (checks and remits) from this paid date are mailed Wednesday. EFTs are available beginning Wednesday. 
  • Fridays: Payments (checks and remits) from this paid date are mailed Monday. EFTs are available beginning Monday. 

Centers for Medicare & Medicaid Services (CMS) ICD-10 resources

 

Conversion tool for Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to ICD-10 (PDF)

 

 

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