We work for better health care, better choices and better health. Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organizations survey readinessthe tool calculates your potential survey score. 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. The health plan worked with NCQA to help test the concepts and application of the accreditation. Providers can receive the most effective, stress-free service. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The AMA is a third party beneficiary to this Agreement. Collect, maintain and present data on race and ethnicity that leads to the development of effective member education, health prevention and patient care management programs. 0000014217 00000 n The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. CPT is a registered trademark of the American Medical Association. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Please expect to purchase texas premier hmo and health insurance providers texas health. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. (PDF) A Profile of Medicaid Managed Care Programs in 2010: Findings It is only a partial, general description of plan or program benefits and does not constitute a contract. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. trailer /Size 49 /Info 8 0 R /Root 10 0 R /Prev 21523 /ID[060e888545013965100abd54e3afe5c1>060e888545013965100abd54e3afe5c1>] >> startxref 0 %%EOF 10 0 obj /Type . 0000007519 00000 n All Rights Reserved. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Were working hard to improve the service, quality and safety of health care. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Health plan accreditation requires the use of HRAs and self-management toolsand though organizations seeking accreditation can opt to build their own HRA or partner with a third-party for the solution, many find themselves weighing the pros and cons of building their own solution and opting instead to partner with a trustworthy vendor. 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. trailer If you dont see what youre looking for below, you can search NCQAs database of additional common questionsor ask a question through My NCQA. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Efforts to reduce disparities in health care could ultimately improve care and reduce overall health care costs. These standards cover areas like care planning, measurement and quality improvement, and care monitoring, to name a few. Purchase and review the program resources, conduct a gap analysis and submit your online application. PDF Aetna is committed to accreditation by the National Committee for The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. We asked members and providers how satisfied they are with Aetna. Providing employees of all racial and ethnic backgrounds with access to quality health care benefits and resources can help them stay healthy. I = Insufficient data; NC = No Credit; NA = Not Applicable . The ABA Medical Necessity Guidedoes not constitute medical advice. In case of a conflict between your plan documents and this information, the plan documents will govern. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Explore health plan accreditation with Wellsource. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Data leads to insight about member health needs, which strengthens our ability to develop targeted initiatives. The accreditations come after Aetna Better Health of Michigan, Inc., participated in an eight-month NCQA sponsored pilot to develop its Health Equity Accreditation Plus evaluation program. 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. Hear about our goals, the progress were making and how were tracking our efforts. See the NCQA Report Card for a directory of accredited organizations. 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. Currently, 14 MCPs are accredited and 15 MCPs are not accredited. Quality Compass is a registered trademark of NCQA. This information is neither an offer of coverage nor medical advice. PDF National Medicaid - Quality Management Accreditation COMMUNICATION - Aetna Its the only evaluation program that bases results on actual measurement of clinical performance (HEDIS measures) and consumer experience (CAHPS measures). FAQs - Health Plan Accreditation - NCQA For over 40 years, health plans, wellness organizations, and companies committed to improving health outcomes This certification signals our commitment to providing a best-in-class solution based on industry best practices and evidence-based research that will support health and improve outcomes. Kristine is based out of Ventura County, California, United States and works in the Hospitals and Health Care industry. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. The NCQA process was Implemented effective 3/1 8/2020 by the Credentialing Department at Aetna Better Health of Louisiana. URL: www.aetna.com. 0 Accreditation HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. 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). NCQA Health Insurance Plan Ratings 2019-2020 - Detail Report (Private) Plan Name: Aetna Life Insurance Company (Ohio) Rating: 3.5. Legal notices Your benefits plan determines coverage. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Align your organizations processes with the CR standards. Reprinted with permission. 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. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. We launched an evidence-based 12-week pilot program with OUI Therapeutics/Vita Health for adults 18+ delivered virtually by clinical specialists to help lower suicide risk. 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. 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. Patient-Centered Medical Home (PCMH) Health Plan Accreditation HEDIS Measures Health Innovation Summit health risk assessment, 0000001192 00000 n Member privacy is paramount. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 0000002555 00000 n Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. As a result, many MCPs already follow NCQA guidelines with regard to care coordination or population health management. Organizations that earn a seal from NCQA show that they are serious about quality health care. 0000001465 00000 n It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. Applicable FARS/DFARS apply. Health Insurance Providers Texas Here's what we did in 2021: Enhancing health and mental well-being leads to a better quality of life. NCQA Accreditation as of June 30, 2019. Health benefits and health insurance plans contain exclusions and limitations. 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. Notification to Authorities and Practitioner Appeal Rights. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. In addition to creating our own initiatives to fight disparities among our members, we encourage researchers at the nations top academic institutions and engage community-based organizations to address variations in health status and health care delivery among racial and ethnic populations. Obtain full pricing information by submitting a request through My NCQA. In case of a conflict between your plan documents and this information, the plan documents will govern. Links to various non-Aetna sites are provided for your convenience only. ncqa, Align your organization's processes with the standards. 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. Out of 26 MCPs in the state, 12 plans currently have NCQA accreditation, and four are pending an accreditation visit. xbbbd`b``l $ u Issues a contract for insurance for a defined population or contracts with an employer to provide managed care services for a self-insured population. The member's benefit plan determines coverage. The certification process requires a substantial amount of time and resources including usability testing, documentation, and product review and enhancement. Align your organization's processes with the CR standards. We work to make your health care better by: Each year, we check to see how close we are to meeting our goals. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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. Asthma drug management Did people, . This Agreement will terminate upon notice if you violate its terms. Applicable FARS/DFARS apply. Regulation involves rules that must be followed, while accreditation is a seal of approval (from some independent accrediting body) certifying that an organization or individual has met specific standards. Money Pit: Is Accreditation Always Worth the Cost? ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Please be sure to add a 1 before your mobile number, ex: 19876543210, follow-up care for children prescribed ADHD medication (ADD), screen for co-existing mental health and substance use disorders, Measure, monitor and improve clinical care and quality of service, Launch company-wide initiatives to improve the safety of our members and communities, Make sure we obey all the rules, whether they come from plan sponsors, federal and state regulators, or accrediting groups, Developing policies and procedures that meet clinical practice standards, Reviewing preventive and behavioral health services and how care is coordinated, Addressing racial and ethnic disparitiesin health care that could negatively impact quality health care, Monitoring the effectiveness of our programs, Studying the accessibility and availability of ournetwork providers, Monitoring the overuse and underuse of services for our Medicare members, Performing credentialing and recredentialing activities, Assessing member and provider satisfaction.
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