November 9, 2018
Ambulatory Surgery Center (ASC) and Acute Hospital EAPG Billing

Dear Provider,
Recently, Aetna Better Health of Ohio (ABHO) received a question regarding if an Ambulatory Surgical Center (ASC) may submit claims using bill type 83X on a UB04.  Traditionally, ABHO received these claims on a 1500 form from ASC providers.  To get an official answer, ABHO posed the question to Ohio Department of Medicaid  to understand if this billing methodology would be accepted under FFS when received by the State for processing.
ODM reviewed the question with Ohio Association of Ambulatory Surgery Centers (OAASC) and at their request, ABHO would like to confirm our policy on submitting these claims to us.  ABHO does not allow these claims to be billed using a bill type 83X on a UB04.   ASCs should bill on a HCFA 1500 form.   Because ABHO is a Duals plan, claims are billed differently than they would be to the state thru FFS.  Effective Immediately Aetna will only accept processing claims for ASC EAPG when submitted on a HCFA 1500 claim form. 

Please also note that Acute Hospital Facilities who are submitting claims with a 83x bill type on a UB04 are also billing incorrectly as well.  Acute Hospital Facilities must be registered as an ASC facility and must bill on a HCFA 1500 form also.  Should you have any questions regarding this communication, please contact Provider Services at 1-855-364-0974.

Provider Services
Aetna Better Health of Ohio