January 28, 2019
Dear Assisted Living Provider,
Aetna Better Health of Ohio recently identified that our system was incorrectly allowing payment on Assisted Living codes when billed by a Skilled Nursing Facility (SNF). Ohio Department of Medicaid (ODM) confirmed for Aetna that Assisted Living claims must be billed using a unique Medicaid ID that is authorized for Assisted Living specifically. Claims that are billed with Assisted Living codes using an NPI and Medicaid ID specific to a SNF should deny. We updated our system to reflect this ODM requirement effective January 1, 2019.
For Aetna Better Health of Ohio providers, Assisted Living facilities may either utilize our atypical NPI for billing (please use 9999999995), or, if available, should utilize an NPI that they have registered for their Assisted Living facility. Either way, the claim must also include the Medicaid ID that is specific to Assisted Living.
This is NOT a change in Ohio Department of Medicaid policy, but was done to align our billing system with the current requirements. If you have billed incorrectly using your Skilled Nursing Facility NPI and Medicaid ID and received a denial, we encourage you to rebill your claims using the correct information to receive payment.   Should you have any questions, please reach out to your Provider Relations Liaison or call our Provider Services team at 1-855-364-0974.

Provider Services
Aetna Better Health of Ohio