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Medicare Direct Coordination of Benefits Cross-Over Issue Background The Centers for Medicare & Medicaid Services (CMS) has a contract with Group Health, Inc. (GHI) whereby GHI receives and sends Medicare claims to secondary payers, including Aetna. Unbeknown to us, GHI implemented a customized eligibility program that caused approximately 70 percent of their eligibility records to be deleted. This affected multiple payers, including Aetna. The interface with eligibility records is critical as it tells GHI which payer should be forwarded the secondary claims. Because the bulk of GHI’s eligibility records were deleted, we received significantly fewer Medicare Direct claims from GHI between July 4, 2006 and July 15, 2006. GHI has corrected this issue by re-adding the affected eligibility records. Since July 16, 2006, Medicare cross-over claims have been successfully reaching us. Claims Recovery Efforts Aetna management teams met with GHI and CMS to discuss the potential of claims recovery. GHI has agreed to send us the affected claims, with limitations. GHI will work with only those Medicare carriers submitting large volumes of cross-over claims. Below is the list of Medicare carriers that participated in the recovery process, along with the dates we received the affected claim files: Carrier Name Administar Empire First Coast Services Options for Florida Highmark Medicare Services Noridian Mutual Insurance Company Palmetto Government Benefits Administrators Wisconsin Physicians Service Carrier Location(s) Date Recovery File Received at Aetna Indiana New Jersey 09/28/2006 09/28/2006 Florida 09/15/2006 Pennsylvania Arizona, Washington, Alaska, Hawaii, Nevada, Oregon Ohio West Virginia Illinois Michigan 09/28/2006 10/02/2006 09/18/2006 09/15/2006 Health Care Administrators: Action Required If the Medicare carrier to whom you submit your Part B claims is on the above list, you do not need to resubmit Part B claims. However, we recommend you perform a “Claim Status Inquiry” within a reasonable time after the week of September 11 to ensure your claims were transmitted to us. If the Medicare carrier to whom you submit your Part B claims is not on the above list, please send the claims, along with the payment information from the Medicare remittance advice, electronically to us. To learn more about submitting electronic coordination of benefits claims to Aetna, please visit: http://www.aetna.com/provider/streamline_office.html Questions? If you have questions not addressed in this announcement, please send us an e-mail by clicking on the “Contact Us” button located at the top of the Web page.