On June 29th, Coventry Healthcare USA will change it’s name to Aetna Better Health of Missouri. There are a few significant changes to note:
- Medical management criteria will change from Mckesson’s Interqual Criteria to Hearst Corporation’s MCG guidelines.
- The directprovider.com portal will no longer be updated with information for this membership.
- The payer ID and claim submission address will change.
I’ve attached the recently published quick reference guide and provider notice regarding this change. If you’re using an eligibility vendor to get the data, make sure that they will be ready to accommodate this change. Any transactions submitted to the old payer ID beginning 8/1/2015 will be rejected. Also any authorization transactions (278) submitted to either the old payer ID or the new payer ID between 6/23/2015 and 6/28/2015 will receive an error message. The payer is advising that you hold these until 6/29.