You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Wellsource, Topics: Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Employers, in turn, will benefit from increased productivity, lower absenteeism and, possibly, lower health care cost increases. If an organization allows its Accreditation status to lapse, its UM, CR or PN Accreditation status will remain in place but may not be renewed. Accreditations See our recognition from trade associations, regulatory agencies and other governing bodies. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers. The ABA Medical Necessity Guidedoes not constitute medical advice. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. Visit the secure website, available through www.aetna.com, for more information. Terms of Use, Patient-Centered Specialty Practice (PCSP), Credentials Verification Organization (CVO), Managed Behavioral Healthcare Organization (MBHO), Health Information Technology Prevalidation Programs, Virtual Seminars, Webinars and On-demand Training, Advertising and Marketing Your NCQA Status, database of additional common questions for Medicare, Medicaid and commercial plans, Use the NCQA Health Plan Accreditation standards to perform a gap analysis and determine improvement areas. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Credentialing Accreditation is for organizations that provide full scope credentialing services. Engage members through pre-clinical coaching to address mental health issues before they become a crisis. Checklist, The Top 3 Benefits of Health Risk Assessments, 3 Healthcare Marketing Trends Taking Center Stage in 2023. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). You are now being directed to the CVS Health site. 0000002094 00000 n
The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Share this page with a friend or colleague by Email. The rigor of this process is one way that accredited organizationscan signal theircommitmentto best practices and quality measures. Ratings emphasize care outcomes (the results of care) and what patients say about their care. Over 1,000 health plan products have earned NCQA Health Plan Accreditation. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. The ABA Medical Necessity Guidedoes not constitute medical advice. 0000004583 00000 n
Treating providers are solely responsible for dental advice and treatment of members. They provide a framework for implementing evidence-based best practices. 0000007519 00000 n
health risk assessment, Align your organizations processes with the CR standards. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Condition-targeted health assessments for service line growth. Please be sure to add a 1 before your mobile number, ex: 19876543210. 3 months before the survey start date: an Accreditation Services Coordinator from NCQA will contact your organization. Were working hard to improve the service, quality and safety of health care. Applicable FARS/DFARS apply. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. The standards align with many state requirements. Kristine works at Ncqa as Assistant Vice President of State Affairs. We do not share your information with third parties. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Copyright 2015 by the American Society of Addiction Medicine. Aetna has taken a leadership role in finding and implementing solutions to the problem of health care disparities and for 10 years has been a catalyst for change. Disclaimer of Warranties and Liabilities. More than 1,000 health plans have earned NCQA Accreditation and achieving accreditation is a lengthy process, representing a lot of work. xb``c``y 3Ps400(e A1$/G #G JReqw@36&c`yXEH10FC PC
Align your organization's processes with the standards. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Your benefits plan determines coverage. Copyright 2023 National Committee for Quality Assurance. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Visit the secure website, available through www.aetna.com, for more information. 0000018200 00000 n
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Interested in other accreditation options? Ratings emphasize care outcomes (the results of care) and what patients say about their care. NCQA Credentialing Accreditation means that the caliber of the CVO's credentialing process is first-class. NCQA is ready to help! NCQA Credentialing Accreditation is a comprehensive program that evaluates the operations of organizations providing full-scope credentialing services, which include verifying practitioner credentials, designated credentialing-committee review of practitioners and monitoring practitioner sanctions. Currently, 14 MCPs are accredited and 15 MCPs are not accredited. Satisfy state requirements and employer needs. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. When billing, you must use the most appropriate code as of the effective date of the submission. Aetna Student Health is the brand name for products and services provided by Aetna Life Insurance Company and its applicable affiliated companies (Aetna). When billing, you must use the most appropriate code as of the effective date of the submission. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". READ SOMETHING ELSE And for good reason if it were easy, just anyone could do it. Purchase and review the program resources, conduct a gap analysis and submit your online application. This accreditation is the latest endorsement that Aetna has received from the NCQA for its products or programs. Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. NCQA Utilization Management Accreditation is a quality assessment program that focuses on consumer protection and customer service improvement. NCQA Health Insurance Plan Ratings 2019-2020 - Detail Report (Private) Plan Name: Aetna Life Insurance Company (Ohio) Rating: 3.5. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. underwritten by Aetna Life Insurance Company (Aetna). The standardized survey process for plans of all types is constantly fine-tuned to keep pace with the changing health care environment. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. We asked members and providers how satisfied they are with Aetna. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Go to the American Medical Association Web site. Patient-Centered Medical Home (PCMH) Recognition Agreement and Collaboration With Clients. Review Handbook and Application. We launched MinuteClinic HealthHUB pilots across four states to demonstrate CVS Healths commitment to mental health and access to mental health services and resources. Understand your population's health risks and improve health outcomes. 45 0 obj
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It's how we show our commitment to improving your quality of care, access to care and member satisfaction. Such data can lead to the development of specific initiatives that improve the health of people of various backgrounds based on their risks for certain conditions. Align your organization's processes with the CR standards. Unlisted, unspecified and nonspecific codes should be avoided. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. OTHER NAMES FOR THIS HEALTH PLAN. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review. Here's what we did in 2021: Enhancing health and mental well-being leads to a better quality of life. Credentialing Accreditation assesses an organizations performance in the following areas: Find the Standards and Guidelines document in the NCQA Store. If you are considering health plan accreditation, you have likely heard of theNational Committee for Quality Assurance(NCQA). Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Maintain Your License. The information you will be accessing is provided by another organization or vendor. Star ratings were created to help beneficiaries assess their care needs against the quality of Medicare Advantage health plans care and service. I = Insufficient data; NC = No Credit; NA = Not Applicable. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. If you are not currently accredited and want to learn more, contact NCQA. Links to various non-Aetna sites are provided for your convenience only. Download, NCQA Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Treating providers are solely responsible for medical advice and treatment of members. Methodology Treating providers are solely responsible for medical advice and treatment of members. We created social media campaigns forLGBTQ and BIPOC youth. NCQA's Health Equity Accreditation Plus helps health care organizations that have implemented core Health Equity Accreditation activities establish processes and cross-sector partnerships that identify and address social risk factors in their communities and the social needs of the people they serve. Accreditation HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 0
U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Members also told us the assistance they received helped them better manage their health, We surveyed members in the Aetna Disease Management program. Help gain accreditation by the National Committee for Quality Assurance (NCQA) and other accreditation organizations. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Links to various non-Aetna sites are provided for your convenience only. This information is neither an offer of coverage nor medical advice. If you are currently accredited and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. and Compliance, Evidence-Based We shared the results with the National Committee for Quality Assurance (NCQA) Quality Compass. 0000001192 00000 n
The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. We have developed strict policies and procedures to protect member information including race, ethnicity and language preference information from inappropriate use and disclosure. The AMA is a third party beneficiary to this Agreement. Regulation and accreditation are not identical. NCQA conducts the survey and determines your accreditation status within 30 days of the final review. CPT is a registered trademark of the American Medical Association. You are now being directed to CVS Caremark site. NCQA accreditation standards help health plans and other organizations align future initiatives with issues that are front and center for employers and states. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Providing employees of all racial and ethnic backgrounds with access to quality health care benefits and resources can help them stay healthy. This evidence-based program provided psychoeducational coaching from clinical specialists to adult mentors. Please log in to your secure account to get what you need. Detailed Health Insurance Plan Ratings for Aetna Better Health Inc., a Pennsylvania Corporation from 2019 - 2020 . More than 173 million people are enrolled in NCQA-Accredited health plans. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. NCQA conducts the survey and determines your accreditation status within 30 days of the final review. Collaborate with Network to access telehealth use analytics and its impact on accessibility and availability. Submit the Application and Pay the Application Fee. HRA, The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. We launched our Caring Contacts program to provide resources and support to Aetna members discharged from an inpatient setting after a suicide attempt. Enter the email address you signed up with and we'll email you a reset link. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Download our case study to learn how vendors earn NCQA certification, and the value this recognition has brought toWellsourceclients for over a decade running. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. xbbbd`b``l $ u
Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. UPMC for You is one of five medicaid plans in Pennsylvania to earn an overall rating of 4 out of 5 in NCQA's Medicaid Health Insurance Plan Health Insurance Plan Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses As with other types of insurance is risk .