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Medical - Aetna Medicare OpenSM Plan Quick Reference Guide

We’ve introduced a new Medicare plan — the Aetna Medicare Open Plan — a Medicare Advantage private fee-for-service (PFFS) plan that provides all the benefits of Original Medicare and more, such as unlimited hospitalization and full coverage of preventive services. Most plan options also include Medicare prescription drug coverage. We encourage you to review this guide and the Aetna Medicare Open Plan Terms and Conditions of Participation for more information.

Advantages and ease of administration
  • No contract required
  • No precertification
  • No referrals
  • Simplified billing (submit one bill and receive one remittance)
  • Medicare-allowable rates paid
Electronic claims submission
  • Submit electronic claims using Aetna’s electronic Payer ID #60054
Paper claims submission
Mail to:
     Aetna Life Insurance Company
     P.O. Box 981107
     El Paso, TX 79998-1107

Submit all paper claims for Covered Services as soon as possible using an Aetna claim form or by using the standard CMS-1500 or UB-04 form.

Claims processing
Claims will be processed in accordance with Original Medicare billing rules, the Medicare Fee Schedule, all prospective payment system requirements, Local Coverage Determinations (LCDs) and the Aetna Medicare Open Plan Terms and Conditions of Participation. With respect to Bundling/Unbundling Logic, Aetna will use Correct Coding Initiative (CCI). Find the link to CCI on the CMS website.

Additional online tools and resources available at www.aetna.com
  • Aetna Medicare Open Plan Terms and Conditions of Participation
  • Aetna Medicare Open Plan Reimbursement Grid
  • CMS Provider Letter
  • Aetna Medicare Open Plan Q&As
  • “Zero” Copayments for Preventive Services
  • Aetna Medicare Open Plan Summaries of Benefits for Individuals
  • Sample CMS claim forms
  • What Health Care Providers Need to Know About PFFS Plans
  • And more ...
Member ID card

member id card

You can find this information online, anytime
Go to www.aetna.com and click on “for Health Care Professionals,” then “Medical” then select “Medicare PFFS” under “Shortcuts” on the left side of the page, or you can visit our secure website for health care professionals, available through www.aetna.com. Once logged in to the secure site, click on “Plan Central” then “Aetna Health Plan” then “Aetna Support Center” then “Doing Business with Aetna,” then “Aetna Benefit Products” and “Aetna Medicare.”

Take our online tutorial — Aetna Medicare Open Plan (PFFS)
This ten minute tutorial covers a plan overview, benefits details and how to work with us. Log in to the secure website, choose “Education” then do a course search for “Aetna Medicare Open Plan (PFFS).”

Provider service center
  • Contact us at 1-800-624-0756
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Health benefits are offered, underwritten or administered by Aetna Health Inc., Aetna Health of California Inc., Aetna Health of Illinois Inc. and/or Aetna Life Insurance Company (Aetna).