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Purchase and review the program resources, conduct a gap analysis and submit your online application. If you have questions about a Med Premier major medical plan, call The Boon Group at the toll-free number on your member ID card. Currently, 14 MCPs are accredited and 15 MCPs are not accredited. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. At least 9 months before desired survey start date: Begin the online application process. 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). The information contained in this article concerns the MCG care guidelines in the specified edition and as of the date of publication and may not reflect revisions made to the guidelines or any other developments in the subject matter after the publication date . No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Weve improved every year from 2017 through 2021 in our Healthcare Effectiveness Data and Information Set HEDIS measures and. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Use the report cards to find health plans, practices, clinicians or other partners that meet NCQA standards and can help you drive improvement, keep people healthy and reduce health care costs. 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. Quality Compass is a registered trademark of NCQA. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). *NCQA-Accredited health plans or MBHOs are eligible for Accreditation in UM, CR or PN if they also maintain health plan or MBHO Accreditation. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The following accreditation status can be found on the National Committee for Quality Assurance (NCQA) website. 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. In 2005 and 2006, the NCQA recognized Aetna for reducing cultural gaps in health care access, and in 2006, Aetna was also the only insurer to receive the prestigious "Recognizing Innovation in Multicultural Health Care Award" from . Aetna's 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). Kristine is based out of Ventura County, California, United States and works in the Hospitals and Health Care industry. 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. The review process is rigorous and may consist of both an onsite and offsite evaluation. #IP#@w"+;#j}2%0Z2 Health Plan Accreditation Our industry-leading accreditation is a rigorous assessment of health plans' structure and process, clinical quality and patient satisfaction . Our quality improvement program helps improve the behavioral health care we provide to you. 0000018200 00000 n Star ratings were created to help beneficiaries assess their care needs against the quality of Medicare Advantage health plans care and service. Links to various non-Aetna sites are provided for your convenience only. Download, NCQA NCQA Reviews the Application. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Applicable FARS/DFARS apply. Below are some of the most frequently asked questions about NCQA Health Plan Accreditation. 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. See Accreditation status and health plan rating for Aetna Health Inc. (New Jersey) on NCQA Report Cards. 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). Go to the American Medical Association Web site. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Kristine works at Ncqa as Assistant Vice President of State Affairs. You will be prompted to log in to your NCQA account. 0000001756 00000 n Pricing is based on multiple factors. More than 1,000health plans have earnedNCQA Accreditation and achieving accreditation is a lengthy process, representing a lot of work. No fee schedules, basic unit, relative values or related listings are included in CPT. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. Additionally, racial and ethnic information is important to a persons health plan. xbbbd`b``l $ u Develop preventive health, early detection and disease management programs and processes. Satisfaction remained high, and members are likely to recommend the program. 0000002094 00000 n Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. We do not share your information with third parties. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. I am a results-driven Health Services professional with over 15 years of experience in Collecting, Organizing, Interpreting, Disseminating various types of data, Project/Program Management . The first step to earning accreditation is a discussion with an NCQA program expert. NCQA conducts the survey and determines your accreditation status within 30 days of the final review. HRA, Treating providers are solely responsible for medical advice and treatment of members. An organization that earns Accreditation meets standards covering more than 100 measured elements. Satisfaction remained high, and members are likely to recommend the program. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. 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. Health plans and accreditation status: Aetna Better Health of California Scheduled We have developed strict policies and procedures to protect member information including race, ethnicity and language preference information from inappropriate use and disclosure. Enter the email address you signed up with and we'll email you a reset link. You are now being directed to the CVS Health site. More people are using telemedicine. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. to learn more about how Wellsource products help organizations prove to accrediting bodies that their programs can measure health risks, segment and stratify populations, target interventions, and provide health education and self-management tools. Each main plan type has more than one subtype. If you are not currently accredited and want to learn more, contact NCQA. Member privacy is paramount. 0000007964 00000 n NCQA conducts the survey and determines your accreditation status within 30 days of the final review. NCQA Utilization Management Accreditation is a quality assessment program that focuses on consumer protection and customer service improvement. The standards align with many state requirements. Issues a contract for insurance for a defined population or contracts with an employer to provide managed care services for a self-insured population. See all legal notices Understand your population's health risks and improve health outcomes. As a result, many MCPs already follow NCQA guidelines with regard to care coordination or population health management. More than 1,000 health plans have earned NCQA Accreditation and achieving accreditation is a lengthy process, representing a lot of work. Some organizations may already be working within NCQA guidelines. Wellsource:NCQA Certified, Committed toQuality andExcellence, Ready to learn more about the NCQA certification process? Visit the secure website, available through www.aetna.com, for more information. Align your organization's processes with the CR standards. Medical organizations . Were working hard to improve the service, quality and safety of health care. The overall rating is the weighted average of a plan's HEDIS and CAHPS measure ratings, plus bonus points for plans with a current Accreditation 0000001781 00000 n 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. As one of the nations leading health plans, Aetnas members represent the countrys increasing diversity in race, ethnicity and language. Create and deliver quality improvement, management or assessment programs and processes. When billing, you must use the most appropriate code as of the effective date of the submission. The AMA is a third party beneficiary to this Agreement. Purchase and review the program resources, conduct a gap analysis and submit your online application.