![]() ![]() Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Members should discuss any matters related to their coverage or condition with their treating provider.Įach benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Treating providers are solely responsible for medical advice and treatment of members. The ABA Medical Necessity Guide does not constitute medical advice. The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. If you share our COB form with your patients, it will help you collect the data you need.īy clicking on “I Accept”, I acknowledge and accept that: Visit the CAQH website for more information on COB Smart We participate in COB Smart™, a Council for Affordable Quality Healthcare ® solution. In these cases, you don't have to send us a Medicare primary COB claim. If the Medicare electronic remittance advice (ERA) or Explanation of Payment (EOP) contains an "MA 18" or "N89" remark code, the Medicare carrier has automatically sent us your claim. * We can accept both Medicare Part A and Part B claims electronically from Medicare. ![]() Use one of our vendors to submit COB claims They may have their own guidelines or tips about submitting COB claims. ![]() When Aetna is secondary, you will need to include the appropriate code on your claim that tells us information about the primary payer’s payment.Ĭontact the practice management support team and/or the clearinghouse you use to submit your electronic claims.
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