«Fax»
Fax Cover Page
Date:
April 2, 2015
To:
HealthCare USA Provider Network
From:
HealthCare USA Provider Relations Department
RE:
Aetna Acquisition
Including this cover sheet, we are faxing 3 pages.
If you have any questions, please contact your provider relations representative at the number(s) listed below. Thank
you for your review and attention to this matter.
Failure to notify HCUSA of important changes can result in many administrative issues including the delay of claims
processing or possible denial of claims. Providers must submit demographic or payment data changes to HCUSA at least 60
days prior to the effective date of change or as soon as possible. These changes include, but are not limited to: • Practice
name • Address • Closure of practice location • Bank Account (EFT) • Phone/Fax numbers • Tax ID • Addition/termination
providers • Additional Languages Spoken • Change in services/providers provided.
All changes should be submitted in writing on office letterhead or by utilizing the Provider Notification Form found under
the Forms Library on www.directprovider.com. All changes should be sent to fax: 1-866-278-9981 or mailed to any of the
addresses listed below. If you have any questions, please contact your Provider Relations Representative or call 800‐213‐
7792, option 4, option 2.
** Confidentiality Notice***
The information contained in this transmission is confidential, proprietary or privileged and may be subject to protection
under the law, including the Health Insurance Portability and Accountability Act (HIPAA). The message is intended for the
sole use of the individual or entity to whom it is addressed. If you are not the intended recipient, you are notified that any
use, distribution or copying of the attached material is strictly prohibited and may subject you to criminal or civil penalties. If
you received this transmission in error please notify us immediately by telephone immediately to arrange for the return of
this material.
If you received this transmission in error or wish to receive this information via email, please contact HealthCare USA
Provider Relations at the phone number listed below or contact your HCUSA Provider Relations Representative.
10 South Broadway, Suite 1200
St. Louis, Missouri 63102
2420 Hyde Park Road, Suite B
Jefferson City, Missouri 65109
10991 NW Airworld Drive
Kansas City, MO 64153
HealthCare USA
10 South Broadway, Suite 1200
St. Louis, Mo 63102
April 2015
Dear HealthCare USA Medical Provider:
In May 2013, Aetna completed its acquisition of Coventry Health Care, Inc. and its subsidiaries and affiliated
companies, including HealthCare USA of Missouri, LLC. The purpose of this letter is to serve as notice of some
changes that will occur in 2015 with our Medicaid plan in Missouri.
Medicaid business to change names
Effective on or about July 1, 2015 and subject to receiving the required state and regulatory approvals,
HealthCare USA, our Missouri Medicaid managed care plan, will change its legal name to Aetna Better
Health® of Missouri Inc.
Contractual Arrangement
The provider contract you currently have in place with HealthCare USA will remain active for the Medicaid
product. No changes at this time.
Operational change – clinical guidelines for medical services
Effective on or about July 1, 2015, HealthCare USA / Aetna Better Health of Missouri will no longer be using
McKesson's InterQual® Criteria for Missouri Medicaid business. Instead, Hearst Corporation’s MCG evidencebased care guidelines (formerly Milliman Care Guidelines) will be utilized for medical criteria. This information
can be viewed on the new web-based provider portal for Aetna Better Health of Missouri, which will become
operational in June 2015.
Operational change – claim submission for medical services
Effective on or about July 1, 2015, all medical claims should be submitted to a new claim submission address
and a new Emdeon Payer ID, which we will provide at a later date. Regardless of the date of service, any
HealthCare USA / Aetna Better Health of Missouri Medicaid claim should be submitted to the new physical
address or through the new EDI payer ID.
Operational change – provider portal
Effective on or about July 1, 2015, there will be a new web-based provider portal available for contracted
providers. Through this tool, providers will be able to verify eligibility, conduct claims inquiry, request prior
authorization, obtain remittance advices, and review clinical guidelines for medical and behavioral health
services. After the effective date, the existing HealthCare USA provider portal (www.directprovider.com) will
no longer be available, except to view historical remittance advices. All transactions for Aetna Medicaid
members on and after July 1st, will be in the new Aetna Better Health of Missouri Portal. We will provide
information on registering for the new provider portal at a later date.
www.hcusa.org
MO-15-02-32
HealthCare USA
10 South Broadway, Suite 1200
St. Louis, Mo 63102
Provider Forums and ongoing communication
During late 2nd Quarter 2015, we will issue more detailed provider communication, and host statewide
Provider Forums and webinars regarding the upcoming changes. Once these are scheduled we will issue
notification to Missouri providers regarding their availability and the registration process. All integration
related materials of interest to providers will be included in provider newsletters and on our website
www.hcusa.org.
Please note that all of the changes listed above only apply to the Medicaid product. If you participate in
other Coventry or Aetna products, these changes do not impact the operational procedures related to those
products. Information relating to other Coventry and Aetna products will continue to be communicated
separately.
Thank you for your participation. We look forward to continuing a successful working relationship with you. If
you have further questions about the information in this letter, please call 1-800-295-6888, or contact your
HealthCare USA Provider Relations Representative.
Sincerely,
Brian R. Dobbins, Esq.
Chief Executive Officer
Aetna Better Health of Missouri