UH - Managed Care Office

Office of Managed Care Operations

AETNA

	Quick Reference Guide
	Telephone Guide
	Claims Address
	ENVOY Electronic Referral
	Aetna Website (This link is provided for the convenience of our website visitors. UMDNJ University Hospital takes no responsibility for the information or proprietary of the web sites listed above.)

AETNA QUICK REFERENCE GUIDE

Facility/Provider # 0013004

*ELECTIVE*	*REQUIREMENTS*
INPATIENT ADMISSION	Authorization Required 5 days prior to admission
SAME DAY SURGERY	Most SDS Procedure Do Not Require Authorization. If Authorization is Required (general anesthesia) 5 days prior to Surgery **Please Contact the Pre Certification Department to Verify if Pre Cert is Required.
OUT PATIENT PROCEDURE	Most Out Patient Procedure Do Not Require Authorization. If Authorization is Required (general anesthesia) 5 days prior to Procedure. **Please Contact the Pre Certification Department to Verify if Pre Cert is Required.

NOTE: Admitting Physician must call to obtain authorization @ 1-800-624-0756 (Pre-Certification). Hospital Admitting Department must call Aetna prior to admission or surgery to make sure admission or surgery has been authorized.

EMERGENCY /DIRECT

EMERGENCY ROOM VISIT	No notification or Authorization required: Self Referral
EMERGENCY ADMISSION	24-hr notification Required by Hospital to obtain Authorization #
DIRECT/EMERGENT ++ADMISSION	24-hr notification required by Hospital or Physician to Authorization #
MENTAL HEALTH/ADMISSION SUBSTANCE ABUSE	See Note Below
NON EMERGENCY MENTAL HEALTH	See Note Below

NOTE: For All Mental Health and Substance Abuse admissions, call Aetna Behavioral Health Services for HMO Benefits contact 800-624-0756 for Traditional & PPO contact 888-632-3862. For All Mental Health & Substance Abuse Pre Certification Contact 800-424-4047.

AETNA QUICK REFERENCE GUIDE

Referral/Pre-Auth. Requirements for Outpatient Services

REFERRAL/SCRIPT REQUIRED OUT- PATIENT

PRE AUTHORIZATION REQUIRED- OUTPATIENT

MAMO-GRAPHY

Nuclear Medicine

90 Bergen Street –Script Required – (Plan Specific)

	150 Bergen Street – Referral Required- (Plan Specific) Routine Radiology
	90 Bergen Street – Script Required – (Plan Specific)
	150 Bergen Street- Referral Required – (Plan Specific)

Ultrasound / Non OB/GYN

90 Bergen Street –Script Required- (Plan Specific)

150 Bergen Street – Referral Required – (Plan Specific)

CT Scan

Radiation Therapy

90 Bergen Street- Script Required – (Plan Specific)

150 Bergen Street- Referral Required- (Plan Specific)

MRI

MRA

PODIATRY

All Home Health Care Services, including Home Uterine Monitoring

Selected Durable Medical Equipment:

Elective (non – emergent) transportation by ambulance or medical van, and all transfers via air ambulance.

All Major Organ Transplant Evaluations and transplants including, but not limited to, kidney, liver, heart, lung and pancreas and bone marrow replacement or stem cell transfer after high-dose chemotherapy.

Aetna HMO Members Only: Chiropractic Therapy Precertification through regional specific managed service organizations (American Chiropractic Network, American Specialty Health and Triad)

Hyperbaric oxygen therapy

Cochlear device and/or implantation

Dental implants and oral appliances.

GI tract imaging through capsule endoscopy

Botox injections – botulinum toxin type A

Mental Health Services

BRCA Genetic Testing

Infertility Program

NOTE: Must Contact Aetna Prior to Having Out Patient Procedures, Depend on Patient Plan. Each Plan is Plan Specific.

NOTE: Aetna Patient Physical Therapy, Occupational Therapy, and Speech Therapy are Excluded OP Services @ University Hospital.
NOTE: All Mental Health Services Must Contact Aetna Behavioral Health Services
@ 1-800-999-5698.
NOTE: Call to verify if Pre authorization for specific procedures
NOTE: Per-certification is required when Aetna is secondary payer.

AETNA TELEPHONE GUIDE

Holly Fritz Hospital & Ancillary Provider Representative 732-914-3989	732-914-3989
Sal Di Salvio Physician Provider Representative	908-686-1096
Karen Mallet Hospital Contract Negotiator	973-625-0453
Viola A. Smith Implementation Specialists Provider E Services for NJ	302-378-1593 Fax: 860-262-7715
Aetna HMO bases benefits plans	1-800-624-0756
Aetna Indemnity & PPO based benefits plans	1-888-632-3862
Aetna Patient Management Department HMO’s	1-800-624-0756
Aetna Patient Management Department	1-800-624-0756
Aetna Patient Management DepartmentOpen Choice PPO & Traditional Plans	1-888-632-3862
Aetna Patient Management Department Managed Choice POS & Elect Choice EPO	1-800223-6857 (8:00 am – 5:00 pm)
Aetna Behavioral Health Services	1-800-424-4047 Benefits 1-800-624-0756 HMO Pre cert 1-888-632-3862 Traditional & PPO Pre Cert �
Aetna Pharmacy Management for Pre-Certification for Oral Medication Only	1-800-414-2386
Aetna Infertility Program	1-800-575-599
Aetna High End Radiology Pre-Certification for Elective Outpatient Care Core National	1-845-298-8155 Fax- 1-845-918-8924
Metro-NY/Northern NJ For HM)-based plan members only. Out Patient Physical & Occupational Therapy Pre-Certification	1-800-771-3205
Aetna Sleep Care Centers	1-800-753-3779

AETNA CLAIMS ADDRESS

For all Aetna Managed Choice, Elect Choice, PPO and Indemnity

Plans, please check the patient ID card for mailing address

AETNA MEDICAL CLAIMS
AETNA Health Inc.
P O Box 981106
El Paso, TX 79998-1106

AETNA DENTAL CLAIMS
AETNA DENTAL
P O BOX 14094
Lexington, KT, 40512-4094

AETNA Enrollment
AETNA
P O Box 24021
Fresno, Ca 93779-4021

CHICKERING (Studento Plans)
Chickering Claims Admin.
P O Box 15708
Boston, Ma 02215-0014

AETNA Behavioral Health
Northeast Clinical Appeal Unit
Mail Code MC1B
1000 Middle Street
Middletown, Connecticut 06457

Aetna Pharmacy Management
P O Box 398106
Minneapolis, MN 55439-8106

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