Filing a Claim
If you receive care from Aetna network providers, they submit claims for you.
If you receive care from an out-of-network provider, your provider may submit a claim for you. However, if your out-of-network provider doesn't submit a claim for you, it is your responsibility to pay the provider in full and submit a claim to Aetna for reimbursement of reasonable and customary (R&C) charges. Claim forms are available from Aetna at the KingCare SM member Web site: www.kingcare.com.
When submitting any claim, you need to include your itemized bill. It should show:
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patient's name;
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provider's tax ID number;
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diagnosis or ICD-9 code;
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date of service/supply; and
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itemized charges from the provider for the services/supplies received.
You also need to provide:
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your name (if you're not the patient);
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your unique identifier number on your ID card; and
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group number 725069.
For prompt payment, submit all claims as soon as possible. Generally, KingCareSM will not pay a claim submitted more than 27 months after the date of service or the date expenses were incurred. If you can't meet the 27-month deadline because of circumstances beyond your control, such as being legally incapacitated, the claim will be considered for payment when accompanied by a written explanation of the circumstances. However, to be considered, the claim must have been submitted by you or Aetna within the 27-month period for submitting a claim.
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