Quickly learn how to bill Aetna for mental health claims.

Like United Healthcare (UHC) and Blue Cross Blue Shield, Aetna is one of the largest health insurance companies in the United States. To contact Aetna and ask a question you can call their customer support line at: (888) 632-3862.

How to Bill Aetna

The first thing you need to do is make sure your client’s mental health benefits are managed by Aetna. Even though they have an Aetna card, it does not always mean Aetna will cover the mental health benefits.

Call Aetna to inquire about the client’s mental health benefits. Call (888) 632-3862.

Follow our benefits verification script to verify your paneling status with the client’s plan. Whether you are in-network or out of network you should ensure you are getting the correct benefits quoted and obtain authorization if it is required.

You can also have us at TheraThink handle it for you. We handle verification and claims with Aetna daily.

Aetna Claims Address: Where To Send Aetna Claims

For most Aetna plans, claims can be sent to:

Electronic Payer ID: 60054
Claims Mailing Address: P O Box 24019 Fresno, CA 93779-4019
Phone Number: (888) 632-3862

What is Aetna’s Timely Filing Limit (TFL)?

The standard Timely Filing Limit for Aetna is 180 days. Typically, claims must be submitted within 180 days from the date of service. However, this can vary depending on the specific insurance plan. If this is not met, a provider can file a dispute. Check Aetna’s Appeals Page for more details.

Do I Need To Be In-Network In Order to Bill Aetna?

Not necessarily. Aetna has many different plans and it can depend on the specific plan whether you can see a client as an out of network provider. We recommend calling to verify your paneling status with the client’s insurance plan.

It is also possible for a provider to be in-network with some plans but not others.

How To Bill Aetna HMO Plans

Generally for Aetna HMO plans, the provider must be in-network in order for the claims to be covered by insurance.

How To Bill Aetna PPO Plans

PPO Plans generally do have out of network benefits. Ask about these when you verify eligibility & benefits.

How To Bill Aetna EPO Plans

These behave like Aetna HMO, except with a wider network.

How To Bill Aetna Medicare Plans

Many of Aetna’s Medicare plans are HMO plans. For Medicare HMO plans the provider must be in-network for benefits to be covered.

Aetna Dental

Make sure the card you received from the client isn’t Aetna Dental. This is a surprisingly common error. A card with dental coverage will not cover mental health services.

How to Bill Aetna EAP

Aetna sells plans that offer EAP (Employee Assistance Program). These plans require authorization and will only cover a set amount of visits. In these cases, you can bill exactly the same as you would a routine visit, but use the EAP modifier code (typically HJ).

How to Bill Aetna Telehealth

Aetna Telehealth Modifier Code is: 95.

Which CPT Codes Should I Use to Bill Aetna?

Mental Health Providers will use:

1. 90791
2. 90834
3. 90837

This is a Nightmare!

We can help you sort out these sorts of things without your input whatsoever.  Our expertise comes in handy daily when parsing out these carve out policies (in all states).  Learn how we can handle your mental health billing today.