Have you received EOB’s that state you are OUT-OF NETWORK but you are NOT? This could be due to an office that has multiple TINs and the charges have been billed out under a TIN that is not IN-NETWORK. If this happens to you, double check to make sure that you are billing the charges under the correct TIN.
While AETNA is a pricer and payor for ASEA/AFSCME, Aetna does NOT determine eligibility for health benefits for the patient. The State of Alaska sends verification of hours work for benefits to the Union by the 15th of each month for the prior month. This is downloaded into the Local 52 computers to pay benefits. If you receive EOB’s stating that the benefits are pending or not eligible for services billed prior the the 15th of the month you may want to resubmit your charges after the 15th or hold your billing for them until after the 15th of each month. Questions, please call the ASEA/AFSCME office at 866-553-8206 for assistance. They are very helpful in answering questions for their members.