Illinois providers: Billing routine vs. medical vision services for Aetna Better Health of Illinois MMAI members

October 2022

All claims submitted for members under the Aetna Better Health of Illinois MMAI (Medicare-Medicaid) plan cannot contain any medical services on the claim. Please use the following information to determine where to send your claims for Aetna Better Health of Illinois MMAI members.

• All claims for medical eye services (treatment for conjunctivitis, glaucoma, etc.) performed by an ophthalmologist (MD/DO) or an optometrist and within the scope of licensure for the Aetna Better Health MMAI plan should be billed to the medical plan. These claims should not be directed to March® Vision Care or it will result in a delay of payment.
• All claims for routine services performed by an optometrist or ophthalmologist for the MMAI plan should be submitted to March Vision Care for reimbursement

For the Aetna Better Health of Illinois MMAI plan, March Vision Care will only accept claims with routine services and deny claims with any medical services listed. As a reminder, routine services are performed when there are no medical eye problems and no symptoms except visual changes that can be corrected by glasses or contact lenses. Medical services are performed for evaluation or treatment for a medical condition or symptom. It is important that medical records reflect all services rendered to the patient.

As a reminder, necessary medical services within the scope of licensure of an optometrist are covered through March Vision Care for Aetna Better Health of Illinois Medicaid members, and those claims can be sent to March for processing.

You can view complete benefit summaries for both Aetna Better Health benefit plans at marchvisioncare.com.