This update from Aetna regarding their new consumer plans came across my desk this week. I think this is the first major payer I’ve seen that won’t be issuing paper/plastic cards.
On January 1, 2016, we’ll be launching new individual consumer plans in four markets. They are called Aetna LeapSM or Innovation Health LeapSM plans.
The counties/cities these plans are available in are:
- AZ – Maricopa
- PA – Bucks, Chester, Delaware, Philadelphia, Montgomery
- NC– Anson, Cabarrus, Cleveland, Gaston, Lincoln, Mecklenburg, Stanley, Union
- SC – Lancaster, York
- VA – Alexandria City, Arlington County, Clarke County, Fairfax City, Fairfax County, Falls Church City, Frederick County, Fredericksburg City, Loudoun County, Manassas City, Manassas Park City, Page County, Prince William County, Shenandoah County, Spotsylvania County, Stafford County, Warren County, Winchester City
As of January 1, we expect to have approximately 150,000 members enrolled in these new consumer Leap plans.
Important Leap Plan Information
- Payor ID – Consumer/Leap plan claims should be submitted using Payor ID 60054.
- Member ID Card – Members with Leap plan benefits will not receive a plastic ID card upon enrollment. They will have access to a digital member ID. They can view or print their digital ID card from their computer or mobile device. A member can provide their physician with a photocopy or a digital version of their ID card right from their smartphone.
- The digital ID card is an electronic version of the Aetna member’s ID card. All information on the digital ID is the same as what is viewable on a physical card.
- Member ID Number – Member ID numbers for Leap Plans will be 12 digits in total. They are ten digits plus two additional digits, based on subscriber or dependents, with no hyphen.
- A Leap Plan member ID will always begin with “10.”
- The subscriber’s two additional digits are always “00.” A dependent’s two additional digits will be “01, 02, etc. This is a change from how a member ID appears on a non-Consumer Business ID card where the subscriber is always “01.”
- Subscriber = 100000134500
- Dependent #1 = 10000013501
- Dependent #2 = 10000013502
- When submitting electronic transactions, including electronic claim submission and paper claim submission, the ID should be entered exactly as shown on the card. For dependents, the first 10 digits of the ID should be entered, followed by the two digits that appear to the left of the dependents’ names on the ID card.
For Eligibility and Benefits inquiry, Family search is not supported for members with consumer (LEAP) plans when using the subscriber’s member ID. ID-only searches will NOT return a subscriber and his/her dependents.
- Inquiries for Consumer (LEAP plan) patients MUST be submitted using one of the following search options:
- Member Name/Date of Birth
- Member ID/Date of Birth (using the “patients” 12-digit ID listed on the member ID card)
- Member ID/Member Name (using the “patients” 12-digit ID listed on the member ID card)
- Referral Submission and Inquiry transactions are NOT supported for Consumer Leap plans as referrals are not required for Consumer Leap plans.