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Dispute & Appeal Process:
State exceptions to filing standard

In the absence of an exception below, Aetna's 180-day dispute filing standard will apply. The exceptions below apply to requests regarding members covered under fully insured plans only.

StateAbbrv.Exception Applies ToTime Allowed to File an Initial Claim Payment Dispute
ArizonaAZAll providers -- participating and nonparticipating1 year
California HMOCAAll providers -- participating and nonparticipating, when the request relates to an HMO member and the date of service is on/after 1-1-04365 days
California TraditionalCAAll providers -- participating and nonparticipating, when the request relates to a traditional member and the appeal is received on/after 6/29/09180 days
ColoradoCOAll providers -- participating and nonparticipating12 months
FloridaFLAll participating or nonparticipating licensed physicians or physician assistants (or practitioners licensed under FL Ch. 458), osteopathic physicians, chiropractors, podiatrists or dentists12 months (does not apply to facilities)
GeorgiaGAAll providers -- participating and nonparticipating12 months from date of claim payment
IndianaINAll providers -- participating and nonparticipating, effective with claims paid on or after 7/1/062 years (from claim payment date)
KentuckyKYparticipating providers only2 years
MarylandMDAll providers -- participating and nonparticipating365 days
New JerseyNJAll providers treating fully-insured NJ contracted members and submitting their dispute using the "Health Care Provider Application to Appeal a Claims Determination Form" will be eligible for review by New Jersey’s Program for Independent Claims Payment Arbitration (PICPA).90 calendar days from the notice of the disputed claim determination
New JerseyNJNo health care provider treating fully-insured NJ contracted members shall seek reimbursement from a payer or covered person for underpayment of a claim later than 18 months from the date the first payment on the claim was made. After 90 calendar days from the notice of the disputed claim determination the provider shall not be eligible for PICPA (see above).18 months from the date the first payment of a claim was made
North CarolinaNCAll providers -- participating and nonparticipating2 years from the original claim payment
OhioOHAll providers -- participating and nonparticipating2 years
OklahomaOKAll providers -- participating and nonparticipating2 years
Rhode IslandRIAll providers -- participating and nonparticipating2 years
TennesseeTNAll providers -- participating and nonparticipating18 months
WashingtonWAAll listed providers -- participating and nonparticipating, effective 1/1/0624 months (or 30 months to request additional payment(s)); 24 months for COB issues)


StateAbbrv.Exception Applies ToTime Allowed to File & Pursue a Dispute
TexasTXAll participating providers and nonparticipating providers who are paid on a participating basis (examples include an emergency situation, a network inadequacy issue, a nonparticipating provider who is pre-approved by Aetna or a hospital-based physician who is a nonparticipating provider but provides services at a participating facility)4 years for claims and non-claims issues -- (complaints are handled as appeals in TX)

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