AETNA BETTER HEALTH® OF VIRGINIA
9881 Mayland Dr
Richmond, VA 23233
1 800-279-1878
Fax 1-844-230-8829
Instructions for Electronic Remittance Advice (ERA) Enrollment/Change/Cancellation
Page 1
Please use this guide to prepare/complete your Electronic Remittance Advice (ERA) Authorization Agreement Form. Missing, illegible or incomplete
information within the agreement form will delay the benefits of participating in ERA. The following is a reference guide only, do not fax, or email
the instructions with the completed authorization form. Return Pages 2-3 ONLY. If you prefer to enroll/change/cancel electronically, please go to our
website at
www.aetnabetterhealth.com/virginia for the electronic form and instructions. If you have questions about the authorization
agreement form or the enrollment process, please contact Provider Relations at 1-800-279-1878, Option 9, or email us at Aetnabetterhealth-
VAProviderRelations@aetna.com.
Please note that the descriptions for the data elements contained in the Electronic Remittance Advice (ERA) Authorization Form have been placed in
an Appendix to make it easier to complete the form. Please refer to the Appendix when completing the form.
Are you using one authorization agreement form per tax id number?
• Enrollment forms containing more than one tax id will be returned.
Did you remember to put the NPI # on the authorization agreement form?
• Enrollment forms without an NPI number (if the provider is required to have an NPI) will be returned.
• List additional NPI numbers to be enrolled in the space provided at the end of the enrollment form.
Additional Information
• Please contact your vendor for additional information on which distribution method to utilize as each vendor/clearinghouse may
have a different distribution method.
• If you do not use a vendor and have questions, please contact Provider Relations at 1-800-279-1878, Option 9, or email
Aetnabetterhealth-VAProviderRelations@aetna.com.
• If you would like to link directly with Emdeon please contact Emdeon Sales at 1-877-363-3666. There may be an additional cost
associated with linking directly with Emdeon.
Need to change or cancel an existing enrollment?
• Complete a new authorization agreement form to make changes to an existing enrollment or to cancel an existing enrollment.
Complete all parts of the form and mark the appropriate choice in the Submission Information section of the form. You are
responsible for notifying Aetna Better Health of Virginia of any information changes.
Has the form been signed by the appropriate individuals?
• Unsigned forms will be returned.
Have you completed all sections?
• Please type or print all requested information clearly. Incomplete and/or illegible fields will cause the form to be returned.
Have a completed form to submit? Forms can be submitted by fax or email.
• Completed new or change authorization agreement forms with voided check and/or bank letter and completed cancellation
authorization agreement forms can be submitted through one of the following methods:
Fax to Aetna Better Health of Virginia Provider Relations at 1-844-230-8829. Only one form per fax. Faxes containing multiple
forms will be returned.
Email to Aetnabetterhealth-VAProviderRelations@aetna.com. Only one form per email. Emails containing multiple forms will be
returned.
Need to check the status of your ERA enrollment?
• Please allow 10-15 business days for processing once enrollment is received. Processing times may vary depending on number of
enrollments received, accuracy of the information provided and how legible the form is.
• The online instructions on our website at www.aetnabetterhealth.com/virginia will instruct you to contact Provider Relations at 1-
800-279-1878, Option 9 or Aetnabetterhealth-VAProviderRelations@aetna.com with any questions or to check enrollment status.
Have you contacted your financial institution to arrange for the delivery of the CORE-required Minimum CCD+ Reassociation Data Elements
from the NACHA ACH/EFT payment file?
• Your financial institution must be a participating member of the Automated Clearinghouse Association (ACH) and accept the CCD+
format. You must proactively contact your financial institution to arrange for the delivery of the CORE-required Minimum CCD+
Data Elements necessary for the successful reassociation of the EFT payment with the ERA remittance advice.
Do you have a Late or Missing EFT payment or ERA remittance advice?
