Issues a contract for insurance for a defined population or contracts with an employer to provide managed care services for a self-insured population. 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. This information is neither an offer of coverage nor 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. 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. Thankfully, NCQA has streamlined part of the process through its vendor certification program, in which vendors can be vetted for quality by NCQAsee the full directory of approved vendors and accredited organizations here. Employees should make sure their doctor knows their racial and ethnic background in order to provide the best medical care. 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. URL: www.aetna.com. Over 1,350 providers have enrolled with a 61% course completion rate. 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. Improved our patient safety programto help members make informed health choices, Used social media to share patient safety information, Provided patient safety resources to physicians on the secure provider website. NCQA Credentialing Accreditation is designed to ensure that organizations pursuing accreditation can maintain a high-quality network for members and contracted clients. Or ask a question through My NCQA. Please log in to your secure account to get what you need. 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. 0000007964 00000 n Below are some of the most frequently asked questions about NCQA Credentialing Accreditation. And we improved performance on many measures. 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. The most important step employers can take is to encourage their employees to voluntarily provide information on their race and ethnicity to both their doctor and their health plan. 0000018200 00000 n CPT is a registered trademark of the American Medical Association. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. 0000014217 00000 n We do not share your information with third parties. Members also told us the information they learned from the program had a positive effect on their lives, and their health improved because of the program. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). If DHCS required NCQA accreditation and followed the NCQA Accreditation as of June 30, 2019. The member's benefit plan determines coverage. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. hbspt.cta._relativeUrls=true;hbspt.cta.load(3949674, '00e7b261-db89-4360-9393-9d0dda543729', {"useNewLoader":"true","region":"na1"}); Tags: This evidence-based program provided psychoeducational coaching from clinical specialists to adult mentors. This button displays the currently selected search type. Open Choice PPO, Aetna Select, Elect Choice EPO, OA Elect Choice EPO, Open Access Aetna Select NCQA Accreditation as of June 30, 2022 I = Insufficient data; NC = No Credit; NA = Not Applicable Contact us at My.NCQA to ask about licensing the ratings data for research or display. Hear about our goals, the progress were making and how were tracking our efforts. NCQA's Health Plan Ratings 2022. 45 26 ncqa, Copyright 2015 by the American Society of Addiction Medicine. 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. to Change Data, Security More than 1,000health plans have earnedNCQA Accreditation and achieving accreditation is a lengthy process, representing a lot of work. Share this page with a friend or colleague by Email. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Health plans and accreditation status: Aetna Better Health of California Scheduled The first step to earning accreditation is a discussion with an NCQA program expert. Some organizations may already be working within NCQA guidelines. 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. Develop robotics expertise and automated solutions for manual work and data entry. HRA, learn more URAC Accreditation for Health Call Center May 1, 2021 - May 1, 2024 Optum Serve Learn more Please be sure to add a 1 before your mobile number, ex: 19876543210. 0000004063 00000 n Obtain full pricing information by submitting a request through My NCQA. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("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. 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). Satisfaction remained high, and members are likely to recommend the program. 0000018693 00000 n In 2019, NCQA rated more than 1,000 health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. The information you will be accessing is provided by another organization or vendor. 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 term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. 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. 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 accreditation process takes an average of 12 months and is the only healthcare industry program that bases results on clinical performance and consumer experience. Treating providers are solely responsible for medical advice and treatment of members. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. The member's benefit plan determines coverage. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 0000001935 00000 n Explore health plan accreditation with Wellsource. Do you want to continue? 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. NCQA Reviews the Application. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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. One way were improving health care quality is by measuring how well we and others are doing. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 0000001192 00000 n It's how we show our commitment to improving your quality of care, access to care and member satisfaction. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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). The AMA is a third party beneficiary to this Agreement. 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. 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 status as of June 30, 2024. Status. Health Standards, Data Accreditations See our recognition from trade associations, regulatory agencies and other governing bodies. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. and Compliance, Evidence-Based 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. Its the only evaluation program that bases results on actual measurement of clinical performance (HEDIS measures) and consumer experience (CAHPS measures). Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Pay the Final Fee and Earn Your License. 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. Also, language and cultural barriers must be eliminated. We take our NCQA accreditation seriously. NCQA Credentialing Accreditation means that the caliber of the CVO's credentialing process is first-class. Applicable FARS/DFARS apply. We asked members and providers how satisfied they are with Aetna. %PDF-1.4 % How do I get NCQA certified? See Accreditation status and health plan rating for Aetna Health Inc. (New Jersey) on NCQA Report Cards. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. 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. For language services, please call the number on your member ID card and request an operator. You are now being directed to the CVS Health site. 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. 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. Contact us Get member help Aetna members have access to contact information and resources specific to their plans. You are now being directed to the CVS Health site. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. NCQA Health Plan Accreditation is a widely recognized, evidence-based program dedicated to quality improvement and measurement. *NCQA-Accredited health plans or MBHOs are eligible for Accreditation in UM, CR or PN if they also maintain health plan or MBHO Accreditation. Credentialing services include: Verifying healthcare provider credentials through a primary source or a contracted agent of the primary source. 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. 0 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 . Below are some of the most frequently asked questions about NCQA Health Plan Accreditation. I = Insufficient data; NC = No Credit; NA = Not Applicable. Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation. Reprinted with permission.
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