AETNA

myNEXUS | Aetna Resources

myNEXUS is proud to announce its partnership with Aetna to provide utilization management for home health services in Georgia, Oklahoma, Texas, and Virginia. Please find important announcements, documents, and forms listed below.

Current Announcements:

  • Upcoming Delegation: Effective August 1st, 2021, myNEXUS will manage Aetna Medicare Advantage (MA) plans in the states of Georgia, Oklahoma, and Virginia. Delegated services include Utilization Management, Network Management, and Claims Reimbursement.
  • Orientation Sessions: myNEXUS is offering training sessions to orient home health agencies with myNEXUS services. Registration for orientation sessions is listed at the bottom of this page. Please select the date and time of your choice below to register for a session.
  • Notice: The delegation notice and orientation letter mailed and emailed to agencies is available here.

 

Authorization Program Materials:

In-Scope Plans:
In-Scope Plan List: The list of in-scope Aetna plans for the myNEXUS delegation.

Authorization Requests:
myNEXUS Provider Portal:
myNEXUS encourages providers to utilize the online Provider Portal to submit authorization requests. The Provider Portal can be found online here.

Initial Authorization Request Form: Fax form to use for initial authorization requests if needed.
Re-Authorization Request Form: Fax form to use for re-authorization requests if needed.

Fax Confirmation Form: Online form providers use to confirm their fax numbers for authorization requests

Out of Network Form: Out of network providers must complete this form to submit authorization requests.

Home Infusion (IV) Therapy:
IV Therapy Information: myNEXUS is not delegated for IV Therapy. This document explain the IV therapy program in detail.

Claims Program Materials:

The myNEXUS payer ID for the Aetna delegation is: 34010. Please find important forms related to the myNEXUS Claims Process listed below.

Electronic Funds Transfer (EFT) Enrollment:
myNEXUS offers EFT payment options for providers. To enroll in the EFT program, please register for EFT payments by either completing the online application form or the paper application form:

Online EFT Application Form
Paper EFT Application Form

Claims Forms:
Payment Dispute Request Form In-Network Providers
Payment Dispute Request Form Out-of-Network Providers

Please contact the myNEXUS Claims Team for questions related to the claims process by calling 833-241-0428.

Provider Information Updates:

If you are an existing myNEXUS Participating Provider and need to update any of your Provider Information (i.e. NPI, address, or phone), please submit the Network Provider Change Form to provider_network@mynexuscare.com or via fax to ATTN: Provider Network at (615) 988-9947.

Online Provider Change Form: Online form providers use to update information.
Printable Provider Change Form: Printable form providers use to update information.

Contact Us:

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 the 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 833-585-6262 or by emailing provider_network@myNEXUScare.com.

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

Phone: 833-585-6262
Fax: 866-996-0077

Provider Orientation Sessions

Full Session: Wednesday, June 30th @ 2pm CT/3pm ET

Full Session: Tuesday, July 6th @ 2pm CT/3pm ET

Claims Session: Thursday, July 8th @ 2pm CT/3pm ET

Full Session: Tuesday, July 13th @ 2pm CT/3pm ET

Claims Session: Thursday, July 15th @ 2pm CT/3pm ET

Full Session: Tuesday, July 20th @ 2pm CT/3pm ET

Claim Session: Thursday, July 22nd @ 2pm CT/3pm ET

Full Session: Wednesday, July 28th @ 2pm CT/3pm ET

Full Session: Tuesday, August 3rd @ 2pm CT/3pm ET

Claims Session: Thursday, August 5th @ 2pm CT/3pm ET

Program Documents

Category Document name Description
Program Materials In-Scope Plan List List of in-scope plans for the Aetna delegation.
Program Materials Fax Confirmation Form Form to complete to confirm fax number for authorization requests.
Program Materials Out of Network Provider Request Form Fax form to use for out of network provider requests.
Program Materials Re-Authorization Request Form Fax form to use for re-authorization requests.
Program Materials Initial Authorization Request Form Fax form to use for initial authorization requests.
Authorization Portal Registration Guide Click here for more information on how to register for the portal.
Program Announcements Texas Provider Notice 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.

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.
Information Updates Network Provider Change Form Form for myNEXUS Participating Providers to update any of your Provider Information (i.e. NPI, address, or phone).
Claims Forms EFT Enrollment Option 2: Complete the Paper Application To complete EFT enrollment, agencies have the option to complete either the online form or submit a paper form. myNEXUS Payer ID for Aetna: 34010
Claims Forms Claims: In-Network Provider Reconsideration Form Form for in-network providers to complete for claims reconsiderations.
Claims Forms Claims: EFT Form Form to complete for EFT enrollment.