Aetna Implementation Resources
myNEXUS is proud to announce its partnership with Aetna to provide utilization management for home health services in Texas.
Important COVID-19 Information
With the heightened international awareness regarding the coronavirus disease of 2019 (COVID-19), myNEXUS would like to provide important reminders for your agency. Please find the myNEXUS announcement regarding these reminders on business disruption, which includes infectious outbreaks and other occurrences that potentially impact all of us and consequently, our members/your patients located online here.
|Program Materials||In-Scope Plan List|
|Program Materials||Fax Confirmation Form|
|Program Materials||Out of Network Provider Request Form|
|Program Materials||Re-Authorization Request Form|
|Program Materials||Initial Authorization Request Form|
|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||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 firstname.lastname@example.org or via fax to ATTN: Provider Network at (615) 988-9947.|
|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||myNEXUS Payer ID for Aetna: 34010|
|Claims Forms||Claims: EFT 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.
Please contact the myNEXUS provider network team with any questions at provider_network@myNEXUScare.com