Don’t miss your opportunity to submit unpaid “add-on” claims to Aetna for adjudication. The deadline to submit claims is July 14.

As reported previously in Alert, Aetna had been denying claims with add-on codes for CAD mammography (CPT codes 76082 and 76083) and myocardial perfusion testing (CPT codes 78478 and 78480), in violation of its RICO settlement agreement. Some physicians even stopped filing claims because Aetna was not paying them. A number of physicians filed RICO settlement compliance disputes and, as a result, in 2005 Aetna began paying for these add-on codes.

CMA and the physicians who filed compliance disputes continued to push Aetna to retroactively pay the previously denied claims for add-on codes. As a result of the compliance disputes and CMA’s ongoing RICO settlement enforcement, Aetna agreed in April to retroactively pay claims with add-on codes for CAD mammography and myocardial perfusion testing with dates of service on or after January 1, 2004.

The money involved is not insignificant. The 19 physicians and physician groups who filed compliance disputes were paid a combined total of $678,000, with one group receiving over $250,000.

The process for resubmitting previously denied claims is described on Aetna’s provider website. Click on “Add-On Code Claims Payment” in the “Features” section in the lower right corner of the top web page. Physicians should submit new claims following standard billing procedures.

More details are available from Aetna’s provider service center (888/632-3862 for PPO plans or 800/624-0756 for HMO plans). Have your tax ID number available when you call.

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.