Virginia Provider Claim Reconsideration Form (Page 2 of 2) in pdf

Virginia Provider Claim Reconsideration Form Page 2

Aetna Better Health® of Virginia

9881 Mayland Drive

Richmond, VA 23233

Claim/Reconsideration Descriptions

Itemized Bill



All claims associated with an Itemized Bill must be broken out per Rev code to verify charges billed on the

UB match the charges billed on the Itemized bill. (Please attach I-Bill that is broken out by rev code with

sub-totals.)

Duplicate Claim



Review request for a claim whose original reason for denial was “duplicate.”



Provide documentation as to why the claim or service is not a duplicate such as medical records showing

two services were performed.

Corrected Claim



The corrected claim must be clearly identified as a corrected claim by writing or stamping “corrected” on

the claim itself.

Coordination of Benefits



Attach EOB or letter from primary carrier and forward to the claims department identifying as “corrected”

claim.

Proof of Timely Filing



For electronically submitted claims provide the second level acceptance report.



Refer to Proof of Timely Filing Requirements in your Provider Manual.

Claim/Coding Edit



Aetna Better Health of Virginia uses two (2) claims edit applications: Claim Check and iHealth. Please

refer to the Provider Manual on the Aetna Better Health of Virginia website

for more information on claim editing.

Corrected claims must be received within 365 of the date on the first remittance advice. Please refer to

the Aetna Better Health of Virginia Provider Manual at , Claims

and Reimbursement Procedures section for more information.

Appeals must be received within 30 days of the date of the incident causing the appeal. Please refer to

the Aetna Better Health of Virginia Provider Manual online at .

VA-16-04-02

Virginia Provider Claim Reconsideration Form Page 2