Gross Point of Rating. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). The PCN (Processor Control Number) identifies the pharmacy benefit processor or Pharmacy Benefit Manager for each health plan (PBM). Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. You can find your Member ID on your ID card, Welcome Letter, or any EOB we sent to you. Box 7012 Downey, CA 90242, Rx PCN for MMA: NCCMS Rx PCN for HDHP: NCHDP Rx PCN for HMO: 70000, HMO Rx BIN: 3585 Rx Group: Not Required Tax ID: 94-1340523 Medicare Part D Rx BIN: 11172 Rx Group: SC Tax ID: 94-1340523 COB Address P.O. Both your group number and your member ID number will be located on your physical ID card and your mobile ID card, which is available on your SimplyInsured dashboard. How Long Does It Take to Receive a Check for a Car Accident Settlement? CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Some subtypes have five tiers of coverage. August 10, 2022 | By Rene Gonzalez | California When customers enroll in health insurance for the first time, change health plans (at any time), or switch insurance providers, they may suffer a delay in receiving pharmacy benefits. The number appears on the back of your Aetna identification card. How much does candid cost with insurance? This is the phone number for the Corporate Contact Center. It is only a partial, general description of plan or program benefits and does not constitute a contract. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Everyone covered by your companys insurance will have the same group number. Gross Point of Rating. WebThe member can activate their card by calling the number on their activation sticker. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. CPT is a registered trademark of the American Medical Association. An automated telephone system will answer your call. Please ensure that the identification number and date of birth you submit are identical to those on file with the George Washington University. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). The group number on the insurance card identifies the employer that purchased a particular health insurance plan. Please be sure to add a 1 before your mobile number, ex: 19876543210. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Member ID/Policy Number. Checking the status of a claim. Both your group number and your member ID number will be located on your physical ID card and your mobile ID card, which is available on your SimplyInsured dashboard. How to become a property and casualty insurance broker? Aetna Inc. 151 Farmington Avenue. Webcheck the H&PBP numbers on the bottom right of the ID card. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. What is a policy number? Box 7012 Downey, CA 90242, Rx PCN for MMA: SCCMS Rx PCN for HDHP: SCHP Rx PCN for HMO: 70000. How much is mavyret pricing disclosure outside insurance? While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. USA. This is the phone number for the Corporate Contact Center. These numbers are located on the front of your member ID card, immediately to the left of the eligible members name. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. The insurance company uses this number to identify your employers health insurance policy. How Long Does It Take to Receive a Check for a Car Accident Settlement? The member should call that number to activate the card and then try to pay again. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Lets say your health insurance plans allowed amount for an office visit is $100 and your coinsurance is 20%. WebYou can find your member ID number on your member ID card. Another term for a prescription is Rx. Typically, medical cards have merely a Member ID number. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. Members should discuss any matters related to their coverage or condition with their treating provider. Your Medicare group number should be on your insurance card for your Medicare Advantage, Medicare Supplement or Part D plan. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. See all of the ways you can contact us In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Hours of operation are Monday through Friday 7 AM to 11 PM ET, Saturday 7:00 AM to 9:30 PM ET, and Sunday 8 AM to 6 PM ET. Need help finding your Member ID? Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Note: Download the Aetna Mobile App for faster, easier access to your Member ID Card. See all of the ways you can contact us So if you purchased your insurance through the Healthcare Market or have a government-based plan such as Medicare, you may not see a group What does GRP mean on an Aetna card? What if I am unable to locate the RxBIN, RxPCN, or RxGroup on the card? Your Medicare group number should be on your insurance card for your Medicare Advantage, Medicare Supplement or Part D plan. When billing, you must use the most appropriate code as of the effective date of the submission. It takes only a few minutes to register. If its not there, you may need to call the customer service number, but you also just might not have one if youre not receiving your coverage through your employer. It is doubtful that your group health insurance number will appear on the back of your card, as the cards front contains all of the most significant information. Disclaimer of Warranties and Liabilities. As the proprietor of an independent insurance agency, you will enjoy complete independence. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. The insurance company name and plan type are in the top header of the card. While ID cards vary according to the health plan that designs them, the group number is a vital piece of information that should be included. Need help finding your Member ID? The majority of pharmacy cards will have all four numbers (Member ID, RxGroup, RxPCN, and RxBIN), although there are a few plans that do not include all four digits but are still approved. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. Medical card example: To process a prescription for medicine, pharmacies often require a pharmacy benefits card, which has a RxGroup, RxPCN, and RxBIN number in addition to the Member ID number. All Rights Reserved. CPT only Copyright 2022 American Medical Association. Go to the American Medical Association Web site. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Not all insurance cards have a group plan number. The corporate headquarters phone lines are staffed Monday through Friday, 8 AM to 6 PM ET. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. If youre wondering where to find your group number on your insurance card, that answer is that it usually will show on the front of your card. When billing, you must use the most appropriate code as of the effective date of the submission. For language services, please call the number on your member ID card and request an operator. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company, Coventry Health and Life Insurance Company and their affiliates (Aetna). Your Medicare group number should be on your insurance card for your Medicare Advantage, Medicare Supplement or Part D plan. For language services, please call the number on your member ID card and request an operator. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. What policy number is shown on an Aetna insurance card? Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). This leads in the subsequent advantages: Freedom from onerous parent company requirements Permission to cross-sell other types of insurance Capability to compare insurers on pricing, product, and service. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. Obtaining Your ID Card Upon receipt of your first premium payment, L.A. Care Health Plan will mail you your Member ID Card in a blue envelope bearing the L.A. Care logo. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Member ID and RxBIN are the two most critical pieces of information required for the pharmacy to locate your health insurance coverage. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Webcheck the H&PBP numbers on the bottom right of the ID card. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. The member should call that number to activate the card and then try to pay again. If you have just Original Medicare, you do not have a group number; nonetheless, your 11-digit Medicare number is printed on your red, white, and blue Medicare card. Others have four tiers, three tiers or two tiers. VUBlueVision Plus. If its not there, you may need to call the customer service number, but you also just might not have one if youre not receiving your coverage through your employer. For example, on CDPHP ID cards, the group number is located on Whats the subscriber name on an insurance card? CPT is a registered trademark of the American Medical Association. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Is my policy number my account number? Is my insurance policy number the same as my ID number? Webnumber is listed on the back of your Aetna ID card. It is doubtful that your group health insurance number will appear on the back of your card, as the cards front contains all of the most significant information. In seconds, it will get you to the right person to help you. How to start a insurance broker business? Where can I locate my Medicare group number? Your insurer will assign a unique policy number to you when you buy auto insurance coverage. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. What is the difference between a medical insurance card and an insurance card for pharmaceutical benefits? What is my Aetna ID number? What is the GRP acronym? Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Please be sure to add a 1 before your mobile number, ex: 19876543210. The group number on the insurance card identifies the employer that purchased a particular health insurance plan. Need extra assistance? Copyright 2015 by the American Society of Addiction Medicine. Unlisted, unspecified and nonspecific codes should be avoided. If you are the policyholder, the last two digits in your number might be 00, while others on the policy might have numbers ending with numeric characters like 01,02, etc. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. You can also provide this number to your health insurance company so they can look up your information when you have questions about your benefits and any recent claims. If you only have Original Medicare, you dont have a group number, but your 11-digit Medicare number is on your red, white and blue Medicare card. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. An insurance group number, if you have an employer-based plan. Note that the gold Medicaid card has simply the Member ID, but the managed care plan includes the Member ID, RxBIN, RxPCN, and RxGroup numbers. Example: W123456789. A printed or digital card is equivalent to a physical identification card. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Check the back of your card first, as it is not usually on the front! Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company, Coventry Health and Life Insurance Company and their affiliates (Aetna). These numbers are located on the front of your member ID card, immediately to the left of the eligible members name. During regular business hours, you can ask to speak with a member services representative. Links to various non-Aetna sites are provided for your convenience only. Your health insurance policy number is typically your member ID number. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. You can add more persons to your insurance as the policyholder, depending on your connection with them. Visit the secure website, available through www.aetna.com, for more information. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. You are now being directed to CVS Caremark site. What does subscriber ID mean? Please log in to your secure account to get what you need. These numbers are located on the front of your member ID card, immediately to the left of the eligible members name. Enter your member ID without spaces or dashes. An automated telephone system will answer your call. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. CPT is a registered trademark of the American Medical Association. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. full name (first and last name) address/zip code/email/etc. It should be labeled as a policy number. If there are any questions, your insurance provider will be happy to help. The ABA Medical Necessity Guidedoes not constitute medical advice. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. This number is always displayed on the cards front. Different Insurance Cards There are several sorts of insurance cards used in a variety of situations, and this article will help you locate the necessary insurance information. back to FAQ listWhere can I find my Member ID number? The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Enter your member ID without spaces or dashes. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Your PCP can be altered at any time. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. In Arizona regular business hours, you will enjoy complete independence typically your member ID card, immediately to left! 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