ACA plan resources for providers

A QHP is a plan that the Centers for Medicare & Medicaid Services (CMS) certifies and meets certain requirements under the Patient Protection and Affordable Care Act (ACA). QHPs have networks that are unique to ACA plans. QHP plans can also be referred to as Exchange Plans or Marketplace Plans.

Exchange members have “QHP” on the upper right corner of the member ID card. The company logo is the on the upper left corner of the card.

• The left side of the card shows the subscriber’s name, ID number, plan number, PCP election and covered dependents, if any. You can also find drug pharmacy details.
• The right side of the card shows the product name, plan name, copay information (e.g., PCP and specialist) and payer ID.
• The back of the card shows specific contact information for ways to reach us, including a toll-free Member Services number. 

The date your patient’s plan starts depends on their sign-up date. In Arizona, Open Enrollment runs from November 1 to January 15. Coverage usually starts on the first day of the month following the plan selection. For example, if your patient selects a plan on December 10, their coverage will start on January 1.

Your patients may qualify to get coverage outside of the Open Enrollment window if they’ve had a big life change or one coming up, such as a new child or the loss of their health plan.

To check a patient’s eligibility, use our Availity^® online portal.

Log in to Availity

Don’t have an Availity account?

• If your practice already uses Availity: Contact your Availity administrator to request a username. If you don’t know who your administrator is, you can call Availity Client Services at 1-800-282-4528 for help.
• If your practice is new to Availity: Set up your Availity account.

Yes, the payer ID and claim address are the same for exchange plans. For information on electronic claims submission, review our claims, payment and reimbursement resources.

We encourage electronic claims submission. However, if you prefer to mail a claim, you can use the address below:

Banner|Aetna
PO Box 14079
Lexington, KY 40512- 4079

You can use our online provider search. 

Banner|Aetna providers: Check participation.

No matter where the member bought their plan, you will verify benefits, eligibility and the PCP on record as you normally do. With our Availity^® provider portal, it’s easy to manage many tasks online. You can submit claims, check claim status and patient eligibility, request precertification, submit disputes and appeals and more.

Log in to Availity

Don’t have an Availity account?

• If your practice already uses Availity: Contact your Availity administrator to request a username. If you don’t know who your administrator is, you can call Availity Client Services at 1-800-282-4528 for help.
• If your practice is new to Availity: Set up your Availity account.

Referrals are not required; however, members must access in-network providers to receive coverage, except for emergencies.*

To find providers in the exchange network, use our provider search.


* Some services and equipment require prior approval, including durable medical equipment, hospital ambulatory surgery, hospital outpatient and radiology and pathology and lab. To confirm benefits, you can call your provider support team at 1-888-632-3862 (TTY: 711). 

We encourage all providers to review our provider manuals and other helpful resources.

• You can use the Provider Data Management (PDM) tool in the Availity^® provider portal to update and maintain your profile. To learn more about the Availity portal you can sign up for training and find resources like our PDM quick reference guide.
• Visit the Availity resource center to get started.