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877 779 5234 Form
Birth
*
*
MEMBER INFORMATION
Member ID/Medicaid ID
*
(MMDDYYYY)
Last Name, First
REQUESTING PROVIDER INFORMATION
Requesting NPI
*
Requesting TIN
*
*0622*
Standard Request - Determination within 10 calendar days from receipt of all necessary information.
Requesting Provider Contact Name
Requesting Provider Name
Phone
Fax
SERVICING PROVIDER / FACILITY INFORMATION
Same as Requesting Provider
Servicing NPI
*
Servicing TIN
*
Servicing Provider Contact Name
Servicing...
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People also ask
-
What is the payer ID for Aetna Better Health Dual Plan Illinois?
Please use the following Submitter ID and Provider ID numbers when submitting claims to the health plan: Submitter ID# 26337 for both CMS 1500 and UB 04 forms. -
What is the phone number for Aetna Medicaid in Illinois?
You can call us at 1-866-329-4701, Monday to Friday, 8:30 AM to 5:00 PM. -
What are the different types of Medicaid in Illinois?
The Department operates three distinct care coordination programs within the broader Illinois Medicaid Managed Care program: HealthChoice Illinois (HCI), YouthCare, and the Medicare Medicaid Alignment Initiative (MMAI). -
What is the group number for Aetna Better Health of Illinois?
Our Member Services phone number is 1-866-600-2139 (TTY: 711). -
Does Illinois Medicaid require prior authorization?
Some prescriptions and over-the-counter medicines require prior authorization for Medicaid reimbursement. Depending upon the drug, either the prescribing physician or the dispensing pharmacist may submit the request. -
What is the payer ID for Aetna Better Health Illinois Medicaid?
Both claims should be submitted to payer ID 68024. -
What is the provider number for Aetna Better Health Illinois?
Aetna Better Health® of Illinois provides the tools and support you need to deliver care. Please view our listing below, which covers forms, guidelines and helpful links. If you need more information or have a question, contact us at 1-866-329-4701 (TTY: 711). -
What procedures does Medicare require prior authorization?
The services most often requiring prior approval are durable medical equipment, skilled nursing facility stays, and Part B drugs. But, each Advantage plan is different. If you have an Advantage plan, contact your plan provider to determine if or when prior authorization is necessary.
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