Aetna Partnership Frequently Asked Questions Form

Aetna Partnership
Provider Frequently Asked Questions

HAP and Aetna have an agreement that allows Aetna to serve as HAP’s national network partner.
HAP and its wholly owned subsidiary ASR Health Benefits are committed to making sure our members have access to quality health care, no matter where they are. This agreement allows HAP EPO and PPO commercial and self-funded members to access Aetna’s nationwide network in other states while being covered through the HAP/ASR statewide network in Michigan and northwest Ohio*.

HAP and ASR will access the Aetna PPO network through the Aetna Signature Administrators™ program, which has more than 1.4 million providers that include more than 6,100 hospitals and thousands of MinuteClinic® locations around the country.

Below are frequently asked questions about this partnership.

Network

1. What members use the Aetna Signature Administrators network? • HAP commercial and self-funded EPO and PPO members have access to Aetna’s nationwide network while traveling or living outside of Michigan or northwest Ohio. • Aetna is the in-network solution for all EPO and PPO members seeking care outside of Michigan and northwest Ohio.
   • All EPO and PPO members, regardless of where they reside, must use the EPO and PPO statewide network for services in Michigan and northwest Ohio.
   • Aetna is considered out of network in Michigan and northwest Ohio.

2. What members are excluded from the Aetna agreement? HAP Medicare Advantage.

3. Will Aetna use HAP’s network? No.

4. Can I provide services to HAP HMO members if I have an Aetna provider contract but no HAP provider contract? HAP HMO members always require prior authorization from HAP to see an out of network provider unless it’s for urgent or emergent care.

   *HAP’s EPO and PPO provider network includes these seven counties of northwest Ohio: Defiance, Fulton, Henry, Lucas, Ottawa, Williams and Wood.

5. Can students insured under HAP HMO, EPO and PPO plans see Aetna providers?
   Below is guidance for students covered under their parent’s plan. For Covered For Students insured under HMO, PPO and EPO group member plans Urgent or emergency care, including mental health services. Prior authorization is not required. Students ages 17 to 25 and enrolled on a parent’s HAP PPO plan Non-emergency care outside of HAP’s network through the Aetna national PPO network at the in-network benefit level. Students ages 17 to 25 covered under parent’s HAP HMO and EPO plans through HAP’s Students Away at School Program. Medical services anywhere in the U.S. With prior authorization from HAP, these students have expanded coverage for services that are normally not covered outside their network. These include: • Non-emergency and minor illness or injury and these related services: − Follow-up visits − Outpatient imaging and lab tests − Short-term physical therapy for rehabilitation − Durable medical equipment (if included in member specific health plan) • Routine allergy injections, flu shots and immunizations • Required maintenance visits for chronic conditions (for example, asthma) • Office visit to get a birth control prescription • Prescription drugs (per member’s plan) To obtain authorization for treatment or services, the student should contact a HAP Students Away coordinator by calling (248) 557-6271 (TTY: 711) or email us at StudentAway@hap.org. For behavioral health concerns, such as depression, anxiety, ADD or ADHD, call (800) 444-5755.

6. How can providers join the Aetna ASA network? Contact Aetna Enterprise at 1-888-MD-Aetna or follow the steps at the Aetna website at www.aetna.com/provider/credentialing.htell. Note: Aetna is responsible for credentialing and contracting.

   ID Cards

7. What do ID cards look like? Below are EPO and PPO samples.

   Eligibility and Benefits

8. How do I verify eligibility and benefits? Contact HAP: • Call (866) 766-4661 • Log in at hap.org and selecting Member Eligibility

Precertification for HAP EPO and PPO members

1. How do I obtain precertification for services? Contact either HAP or American Health Holding (AHH). AHH is Aetna’s utilization and care management service provider. They provide full utilization management and case management for ASR and limited utilization management for HAP EPO and PPO members. Please see the table below for details on appropriate contact for precertification. (Note: For prior authorization for Students Away at School program, see information above). For HAP EPO and PPO Members Contact Living inside Michigan seeking care inside Michigan • Preservice • Urgent/Emergent • Post-Acute HAP To see requirements: Log in at hap.org; select Quick Links; Procedure Reference Lists; Services that Require Prior Authorization List

   To submit request: Log in at hap.org and select Authorizations. Living outside Michigan* • Preservice • Urgent/Emergent • Post-Acute American Health Holding (AHH) (800) 641-5566 This number can also be found on the member’s ID card.

   Living inside Michigan seeking care outside Michigan (traveler) • Preservice
   • Urgent/Emergent • Post-Acute Excluding HAP’s EPO and PPO provider network of these seven counties of northwest Ohio: Defiance, Fulton, Henry, Lucas, Ottawa, Williams and Wood.

   • Behavioral health and pharmacy are excluded from AHH relationship. Instead, contact HAP. • Note: We have a partnership with TurningPoint for prior authorization for specific cardiac surgical procedures and diagnostic services, and musculoskeletal conditions. For prior authorization requirements:
   − Log in at hap.org; select Procedure Reference Lists under Quick Links

   Billing and Reimbursement

2. Where do I submit claims? All claims should be submitted to HAP. Refer to the back of the member’s ID card.

3. How do I know if the claim was processed on the Aetna network on my Remittance Advice? There will be an explanation code of L29 – Aetna Contract Applied.

   Claims Appeals

4. How do I appeal a claim denial or pricing issue? Contact HAP: • Call (866) 766-4661 • Log in at hap.org

   • Select Claims (to appeal a single claim) or Remittance Advice (to appeal several claims)
   • Choose the appeal type, Aetna Pricing Dispute

   Provider Directory

5. How do I find doctors in Aetna’s national PPO network? Visit hap.org/find-a-doctor and select Care Outside of Michigan.