Members should discuss any matters related to their coverage or condition with their treating provider. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. xbbbd`b``l $ u If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 0000001756 00000 n Measure the performance and outcomes of our programs and processes. Has a process for monitoring, evaluating and improving the quality and safety of care provided to its members, Reports audited HEDIS results for designated HEDIS. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Purchase and review the program resources, conduct a gap analysis and submit your online application. NCQA Credentialing Accreditation means that the caliber of the CVO's credentialing process is first-class. 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. 2 Based on results from the 2021 Aetna Disease Management Member Satisfaction Analysis. The rigor of this process is one way that accredited organizationscan signal theircommitmentto best practices and quality measures. Applicable FARS/DFARS apply. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 0000000816 00000 n Over 1,350 providers have enrolled with a 61% course completion rate. Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation. 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 . Submit the Application and Pay the Application Fee. to Change Data, Security NCQA Utilization Management Accreditation is a quality assessment program that focuses on consumer protection and customer service improvement. *NCQA-Accredited health plans or MBHOs are eligible for Accreditation in UM, CR or PN if they also maintain health plan or MBHO Accreditation. 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. When expanded it provides a list of search options that will switch the search inputs to match the current selection. kBtUp+v;J~)k>x@4l1%RuMALe0>6L(h(yI nL`suT;,y=PO#f{{0!4H6ISwB1"`rX`\'J$tS We work for better health care, better choices and better health. The NCQA process was Implemented effective 3/1 8/2020 by the Credentialing Department at Aetna Better Health of Louisiana. have relied on Wellsource for innovative, evidence-based, NCQA-certified health risk assessment solutions to No fee schedules, basic unit, relative values or related listings are included in CPT. 45 0 obj <> endobj Satisfaction remained high, and members are likely to recommend the program. Applicable FARS/DFARS apply. If you do not intend to leave our site, close this message. Some subtypes have five tiers of coverage. 0000018200 00000 n NCQA Credentialing Accreditation assesses any organization that offers credentialing services to ensure the organization can maintain a superior network for its contracted clients. Some organizations may already be working within NCQA guidelines. Over 1,000 health plan products have earned NCQA Health Plan Accreditation. Create and deliver quality improvement, management or assessment programs and processes. health risk assessment, Asthma drug management Did people, . Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Go to the American Medical Association Web site. You are now being directed to the CVS Health site. Develop preventive health, early detection and disease management programs and processes. 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. 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. Review Handbook and Application. We worked with BrandWatch to get social media analysis of mental health findings for adolescents and LGBTQ/BIPOC youth. Reprinted with permission. health plans. 0000018406 00000 n Align your organizations processes with the CR standards. Aetna Health Inc. . trailer Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Copyright 2015 by the American Society of Addiction Medicine. Contact us Get member help Aetna members have access to contact information and resources specific to their plans. Your benefits plan determines coverage. CPT only Copyright 2022 American Medical Association. The issue of health care disparities is immensely complex, but there are targeted solutions that can help us bridge the gap. Providers can receive the most effective, stress-free service. Reprinted with permission. NCQA health plan accreditation is a widely-recognized, evidence-based program that works to ensure quality improvement and measurement through aligning organizations with a comprehensive framework. View Kristine Toppe's email address (t*****@ncqa***.org) and phone number. See Accreditation status and health plan rating for Aetna Health Inc. (New Jersey) on NCQA Report Cards. How do I credential with UnitedHealthcare? OTHER NAMES FOR THIS HEALTH PLAN. The Benefit ofWorking with Certified Vendors to Achieve Health Plan Accreditation, As described above, seeking accreditation is anarduous process. 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. Kristine is based out of Ventura County, California, United States and works in the Hospitals and Health Care industry. Visit the secure website, available through www.aetna.com, for more information. The first step to earning accreditation is a discussion with an NCQA program expert. Employees should make sure their doctor knows their racial and ethnic background in order to provide the best medical care. 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. Medi-Cal Managed Care Health Plan (MCP) Accreditation Status August 2019. Accreditations See our recognition from trade associations, regulatory agencies and other governing bodies. Aetna is committed to Accreditation by the National Committee for Quality Assurance (NCQA) as a means of demonstrating a commitment to continuous quality improvement and meeting customer expectations. If you are not currently accredited and want to learn more, contact NCQA. Download our case study to learn how vendors earn NCQA certification, and the value this recognition has brought toWellsourceclients for over a decade running. Health Standards, Data 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. We also give you and your doctors information and tools that can help you make decisions. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. It is only a partial, general description of plan or program benefits and does not constitute a contract. The National Committee for Quality Assurance's (NCQA) Diabetes Recognition Program (DRP) recognizes clinicians who have met standards demonstrating delivery of high-quality care to patients with diabetes. Some organizations may already be working within NCQA guidelines. 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, 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. If you dont see what youre looking for below, you can search NCQAs database of additional common questionsor ask a question through My NCQA. Weve partnered with Psych Hub to offer a customized suicide prevention training and certification program to all contracted network behavioral health and EAP providers at no cost. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.