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Wiki 2nd level appeals for Medicare Part C

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orthobiller2017

Networker
Messages
45
Location
East Northport, NY
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We have many claims being denied by Aetna for no precertification. As per availity, no preauth was necessary but Aetna saying it was. We have done provider appeals with availity screenshots which are being upheld. It is my understanding captured medicare (even if plan is fully insured) is not regulated by the state DFS. What further options do we have. Per the denial letters doesnt seem like Aetna is sending it to IDR

Any advice?

Thank you!

Provider rep is not really an option
 
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