AETNA

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

Current Announcements:

PA & WV July 1st, 2022 Delegation Information:

  • Upcoming Delegation: Effective July 1st, 2022, myNEXUS will manage Aetna Medicare Advantage (MA) plans in the states of Pennsylvania and West Virginia. Delegated services include Utilization Management, Network Management, and Claims Reimbursement.
  • Notice: The delegation notice and orientation letter mailed and emailed to agencies is available here.
  • Orientation Sessions: myNEXUS is offering training sessions to orient home health agencies with myNEXUS services. There are two different training session options: full sessions covering authorization and claims or a claims only session.
  • Orientation Registration:  Please select the session of your choice below to register:

Agency Information Form:

Please complete the “Agency Information Form” to have your agency’s information added to the myNEXUS system. The form is found online 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

Home Infusion (IV) Therapy:
IV Therapy Information: myNEXUS is not delegated for IV Therapy. This document explains 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

Claims Waiver of Liability Form for Out of Network Providers

Claims Notices:
NOA Notice:
Effective January 1st, 2022
HIPPS Code Notice:
Effective April 15th, 2020
RAP Claim Notice:
Effective January 1st, 2021

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 Provider Change Form found below.

Provider Change Form: Online 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