What is the Aetna Open Negotiation Request Form and How It Works?

Definition & Meaning

The Aetna Open Negotiation Request form is a crucial document for out-of-network healthcare providers seeking to negotiate payment rates with Aetna under the federal No Surprises Act (NSA). This form allows providers to formally initiate a negotiation process within 30 business days of receiving an out-of-network claim payment. The goal of this negotiation is to reach a mutually agreeable payment amount for covered services, thereby preventing unexpected medical bills for patients.

How to Use the Aetna Open Negotiation Request Form

To effectively utilize the Aetna Open Negotiation Request form, providers must follow a structured process:

• Receive Payment Offer: After submitting a claim, the provider receives an out-of-network payment offer from Aetna.
• Submit the Form: The provider must complete and submit the Aetna Open Negotiation Request form along with the federal Open Negotiation Notice form within 30 days of the payment offer.
• Engage in Negotiation: A 30-business-day negotiation period commences, during which the provider and Aetna discuss the payment terms.
• Independent Dispute Resolution (IDR): If no agreement is reached, the provider can escalate the matter to IDR, where an arbitrator will determine the final payment amount.

How to Obtain the Aetna Open Negotiation Request Form

Providers can obtain the Aetna Open Negotiation Request form through several channels:

• Aetna Provider Portal: Providers can log in to the Aetna provider services website to download the form directly.
• Contact Aetna Support: Providers may also contact Aetna's customer service for assistance in acquiring the form.
• Healthcare Associations: Many healthcare associations provide resources and access to necessary forms, including the Aetna Open Negotiation Request form.

Steps to Complete the Aetna Open Negotiation Request Form

Filling out the Aetna Open Negotiation Request form requires careful attention to detail. Here are the steps:

• Provider Information: Enter the provider's name, contact information, and NPI number in the designated fields.
• Claim Details: Provide specific details about the claim, including the claim number and date of service.
• Payment Offer: Include the payment amount offered by Aetna and the reasons for the negotiation request.
• Signature: Ensure that the form is signed and dated by an authorized representative of the provider.

Who Typically Uses the Aetna Open Negotiation Request Form

The Aetna Open Negotiation Request form is primarily used by:

• Nonparticipating Providers: Doctors, specialists, and facilities that do not have a contract with Aetna.
• Air Ambulance Services: Providers offering emergency transport services that may not be in-network.
• Healthcare Facilities: Hospitals and clinics that provide services to patients covered by Aetna but are not part of the network.

Key Elements of the Aetna Open Negotiation Request Form

Understanding the key elements of the Aetna Open Negotiation Request form is essential for accurate completion:

• Provider Identification: This section captures the provider's details, ensuring Aetna can verify the request.
• Claim Information: Accurate claim details help Aetna locate the specific case for negotiation.
• Negotiation Rationale: Providers must clearly articulate why the initial payment offer is insufficient, providing supporting documentation if necessary.
• Submission Date: The date of submission is critical, as it marks the beginning of the negotiation period.

Examples of Using the Aetna Open Negotiation Request Form

Here are practical examples illustrating the use of the Aetna Open Negotiation Request form:

• Example One: A surgical center receives a payment offer for a procedure that is significantly lower than the average market rate. They submit the form to negotiate a higher payment based on regional pricing standards.
• Example Two: An out-of-network physician receives a claim payment for a complex treatment. They believe the payment does not reflect the service's complexity and submit the request form with detailed documentation of the procedure.

Legal Use of the Aetna Open Negotiation Request Form

The Aetna Open Negotiation Request form is legally recognized under the No Surprises Act, which aims to protect patients from unexpected medical bills. Providers must adhere to the following legal guidelines:

• Timeliness: The form must be submitted within 30 business days of receiving the initial payment offer to be valid.
• Accuracy: All information provided must be truthful and accurate to avoid potential legal repercussions.
• Compliance: Providers must comply with all applicable federal and state regulations when using the form.