![aetna timely filing for appeals aetna timely filing for appeals](https://www.pdffiller.com/preview/202/427/202427704.png)
Situation (assume 180-day timely filing rule) – The date of service was March 1, 2020. On July 31, one day remains to file the claim.
![aetna timely filing for appeals aetna timely filing for appeals](https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/maryland/images/AetnaBrandOnly_RightsManaged_0464%201920x555.jpg)
If the National Emergency were over on June 1, 2020, 60 days later is July 31, 2020. Outcome – The time to file this claim is suspended starting on March 1, 2020, until 60 days after the National Emergency is declared over. The claim entered day 179 of the 180-day timeline on Feb.
![aetna timely filing for appeals aetna timely filing for appeals](https://cdn.spinenation.com/images/articles/727-tile.jpg)
Situation (assume 180-day timely filing rule) – Service was rendered on Sept. Outcome – The rules to suspend timely filing do not apply. Situation (assume 180-day timely filing rule) – The time for a claim to fulfill the timely filing rule expired on Feb. Timely filing limits may vary by state, product and employer groups. To help providers and individuals meet timely filing rules, the period from March 1, 2020, to 60 days after the announced end of the National Emergency will not count towards timely filing requirements.
![aetna timely filing for appeals aetna timely filing for appeals](https://www.pdffiller.com/preview/404/120/404120126.png)
The member's benefit plan determines coverage. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Members should discuss any matters related to their coverage or condition with their treating provider.Įach benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Treating providers are solely responsible for medical advice and treatment of members. The ABA Medical Necessity Guide does not constitute medical advice. The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions.