By providing this information, Meritain Health is not exercising discretionary authority or assuming a plan fiduciary role, nor is Meritain Health providing legal advice. It is recommended that plans consult with their own experts or counsel to review all applicable federal and state legal requirements that may apply to their group health plan.
It is believed to be accurate at the time of posting and is subject to change. This content is being provided as an informational tool. Inpatient precertification must be requested at. The form linked below should be completed by a member who needs to grant access to their PHI to another individual in connection with an appeal. Aetna will certify the medical necessity and length of any applicable hospital confinement for inpatient care. The form linked below should used by a member who would like to grant permission to another individual to act on their behalf in connection with an appeal.
Please note, the claims appeal procedure is explained at length within each group’s Summary Plan Description (SPD). Submission of these forms to the Meritain Health Appeals Department without a formal written appeal from the provider will not be reviewed. The formal written appeal and these forms would then be sent to the address of the Meritain Health Appeals Department (listed on form) by the provider. There are two forms listed below that a member must complete and give to the provider submitting the formal written appeal. Once we receive the request form, the request for external review will be handled in accordance with federal law and/or state law, depending upon the benefit plan. Meritain Health requires the member to complete an appeals form to indicate a request for external review.
Please forward this completed form to the privacy officer of the employer or to: The member whose information is to be released is required to sign the authorization form.Īll sections of the form must be complete for the form to be considered. Your signature and your understanding of what it means Purpose: why do you want the information released?
Who you authorize to receive your PHI information for example, spouse, child or friend Employee information: if you are NOT the employee of the plan
#AETNA TIMELY FILING LIMIT HOW TO#
The following is a description of how to complete the form. For example, creditable prescription drug coverage from an employer or union that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.The Authorization for Release of Information form is required according to the guidelines set forth in the Health Insurance Portability and Accountability Act (HIPAA), specifically 45 CFR § 164.508 of the HIPAA Regulations. *If you don’t have a creditable prescription drug coverage for 63 days or more, you may have to pay a late enrollment penalty. You’ll return to Original Medicare if you switch from a Medicare Advantage plan (with drug coverage) to a Medicare prescription drug plan.* Important Note: If you change from a Medicare Advantage plan that includes prescription drug coverage to a Medicare prescription drug plan, this will disenroll you from your Medicare Advantage plan. There are only certain times when you can disenroll. We'll let you know if you're able to leave your plan. Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD)Ĭall us at the number on your ID card if you want to leave your current plan and not join another one.
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