AETNA

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 January 1st, 2022, myNEXUS will manage Aetna Medicare Advantage (MA) plans in the states of Kentucky, Missouri, and Ohio. 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. Please register for an orientation session online here.
  • Notice: The delegation notice and orientation letter mailed and emailed to agencies is available here.

Agency Information Form:

The agency information form can be 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

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 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 Notices:
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 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

Program Documents

Category Document name Description
Program Materials Fax Confirmation Form Form to complete to confirm fax number for authorization requests.
Program Materials Aetna Plan Grid for Website 8.1.2021 Aetna Plan Grid for Website 8.1.2021 including new states
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 Aetna Payment Dispute Request Form Out-of-Network Providers Fillable payment dispute request form for out-of-network providers.
Claims Forms Payment Dispute Request Form for In-Network Providers Fillable payment dispute form for in-network providers.
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: EFT Form Form to complete for EFT enrollment.