Aetna Implementation Resources

myNEXUS is proud to announce its partnership with Aetna to provide utilization management for home health services in Texas.

Program Announcements

Effective March 1, 2020, myNEXUS will manage Aetna Medicare Advantage (MA) plans in the state of Texas. Delegated services include Claims Payment, Provider Network, and Utilization Management.

Texas Provider Notice

Home health-related requests for in-home skilled nursing, physical therapy, occupational therapy, speech therapy, home health aide, and medical social work will now require pre-authorization from myNEXUS. Claims for home health services for Aetna Medicare Advantage Members will also be paid by myNEXUS. This will occur for services administered in a home or residence for Aetna Medicare Advantage members in Texas.

Provider Orientations

myNEXUS will lead informational sessions designed to orient you and your staff with our services. There are several dates and times available to you and your staff for a web orientation session with the myNEXUS Provider Network team. Each session will last approximately one hour.

Please find orientation dates and times listed here

Provider Materials

Please follow the links below for program materials:

In-Scope Plan List

Initial Authorization Request Form
Re-Authorization Request Form

Claims: EFT Form
Claims: In-Network Reconsideration Form
Claims: Out of Network Payment Dispute Form
myNEXUS Payer ID for Aetna: 34010

myNEXUS utilizes CMS National and Local Coverage Determinations (NCD and LCD’s) when applicable, or Aetna medical policies and clinical Utilization Management guidelines to facilitate appropriate evaluation of medical necessity by including assessment of the member throughout the continuum of care. A synopsis of the criteria is available to Providers and Members on request and free of charge by calling myNEXUS at 844-411-9622 or by emailing provider_network@myNEXUScare.com.

Provider Authorization Portal

myNEXUS Portal
For information on how to register for the portal, please click this link.

Contact Us

Phone: 1-833-585-6262

Please contact the myNEXUS provider network team with any questions at provider_network@myNEXUScare.com.