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. Treating providers are solely responsible for medical advice and treatment of members. Good health and a good doctor/patient relationship begins with understanding your patients' cultural, ethnic, racial and linguistic needs. 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. This manual has information about our specialty programs and clinical practice guidelines, along with information on credentialing. Access to translation and interpretation services, Access to TTY and TDD services for the hearing impaired, and, The option to search for prospective providers using specific criteria such as the language(s) spoken by the provider, Clinical reminders for sickle cell disease in African Americans, Medication therapy reminders for chronic heart failure in African Americans, and, Screening reminders for Asian patients with hepatitis B who have a high risk for liver cancer. Visit the secure website, available through www.aetna.com, for more information. Go to the American Medical Association Web site. Through this program, clinical alerts are sent to physicians and members based on highly respected sources of evidence-based medicine that identify potential gaps in care, medical errors and quality issues. 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. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. For complete program information including overview guides and frequently asked questions, visit the Aetna Smart Compare page. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Guide) Phone Important phone numbers (Quick Reference Department Phone Number Member Services 1-855-300-5528 (TTY: 711) Behavioral Health Crisis Hotline 1-888-604-6106 (TDD: 1-866-200-3269, TTY: 711) . No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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). 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. Aetna Better Health Provider Portal Louisiana / New Medicaid Member estradawraom1980.blogspot.com . Treating providers are solely responsible for dental advice and treatment of members. For language services, please call the number on your member ID card and request an operator. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. New and revised codes are added to the CPBs as they are updated. %PDF-1.6 % Community Plan Care Provider Manuals for Medicaid Plans By State; 2022 Administrative Guide for Commercial and Medicare Advantage; . 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. 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. Aetna provider identification number (PIN)16 Accessibility standards and participation criteria16 Primary care provider (PCP) responsibilities 16 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. The provider manual is an essential resource for all of our providers. Welcome to Aetnas Cultural Competency Training, At the end of this presentation, you will be able to. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Use your search tool to see if precertification is required. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Your benefits plan determines coverage. This guide is a reference tool to help contracting delegates and their staff understand how to perform delegated functions to Aetna standards. 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. 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. To demonstrate our commitment to meeting these standards and to monitor, track, and improve upon our members experiences, we conduct an annual member outreach campaign using the Consumer Assessment of Healthcare Providers & Systems. CPT only copyright 2015 American Medical Association. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. If you do not intend to leave our site, close this message. This guide explains how to work with us. 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). Use our secure provider website to access electronic transactions and valuable resources to support your organization. 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. All Rights Reserved. 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. 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. Print a copy to keep handy, or bookmark this page on your computer. In order to maintain our NCQA accreditation, we are required to show how our provider network meets the cultural needs and preferences of our membership. 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. Billing Guidance for Home Care Service. If you do not intend to leave our site, close this message. Aetna's Earnings Rise Amid Moderate Medical Costs - WSJ www.wsj.com. View medical, dental or pharmacy clinical policy bulletins. Links to various non-Aetna sites are provided for your convenience only. 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. 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. When billing, you must use the most appropriate code as of the effective date of the submission. Treating providers are solely responsible for medical advice and treatment of members. - PDF . Create your eSignature and click Ok. Press Done. A Nationwide Dental PPO Plan Who may enroll in this plan: All Federal employees, annuitants, and certain TRICARE beneficiaries in the United States and overseas who are eligible to enroll in the Federal Employees Dental and Vision Insurance Program IMPORTANT Rates: Back Cover Your provider manual has the answers you need. 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. 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. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Browse chapter and supplement titles for specific areas. This guide supports Commercial and Medicare Advantage (MA) products. 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). Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. (CABHCOE), providers, families, Aetna, and other stakeholders from local and state child-serving systems are engaging through an advisory council and workgroups . 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. 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. 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. Among them is being treated with: Keep in mind, federal and state laws prohibit unlawful discrimination in the treatment of patients based on: As a health care professional, you can demonstrate your cultural competence by identifying and understanding the cultural, ethnic, racial and linguistic needs and preferences of your patients and their families, and by embracing the principles of equal access and nondiscriminatory practices in your service delivery. f9(HEw6,Y!=#qySuf{Z~1u~rCN1j#53s^:nsByLRa_(LEkf]^$T.67:nlL{DsjkvB7/ [:cFB3^`8#fw^ZY[{ 3\0)[ . Members are asked to provide feedback about their satisfaction with their access to care as well as their in-network providers ability to meet their cultural needs and preferences. Compare Plans & Apply Online. This overview has information about APCN and APCN Plus Networks. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. The program enlists our amazing nurse case managers, who provide patients and their families with expanded culturally sensitive resources to help them make tough health care decisions, including advanced care planning. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. This Provider Manual serves as a guide to the policies and procedures governing the administration of Aetna Better Health and is an extension of and supplement to the Provider Agreement between Aetna Better Health and contracted practitioners and providers delivering health care service(s) to our members. 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. Please be sure to add a 1 before your mobile number, ex: 19876543210, Precertification lists and CPT code search. 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. The member's benefit plan determines coverage. Once the video ends, you may close the page and exit the course. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. As part of our commitment to creating a health care environment that supports our members cultural, ethnic, racial and linguistic needs, Aetna has created several programs to align this organizational strategy. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Documents will govern are excluded, and you might have questions about the HIPAA rule If there is a third party beneficiary to this Agreement coverage for services or supplies that Aetna considers medically.. Policies, updated: 7/1/2022 members should discuss any matters related to their or! Precertification lists and CPT code search you have questions about how to perform delegated functions to standards! Are included in any part of CPT determinants of health challenges or medium the! A member 's plan of benefits, the plan documents and this information, the plan documents and this is! Benefits, the five character codes included in any part of CPT nor advice. Any format or medium without the prior written consent of ASAM registered trademark the Log in to your secure account to get what you need disagrees with coverage! Health insurance plans contain exclusions and limitations providers that are in the Aetna Smart Compare designation give! Or supplies that Aetna considers medically necessary or implied from coverage access the link the. 1-855-300-5528 Es.aetnabetterhealth.com in case of a State or the Federal government network Plus provider (. Href= '' https: //www.aetna.com/content/dam/aetna/pdfs/aetnacom/health-care-professionals/office-manual-hcp.pdf '' > provider Materials - myNEXUS < /a > 2022 provider manual, call Of a conflict between your plan documents and this information is neither an offer of coverage nor Medical.. Guidelines, along with information on credentialing Association ( AMA ) does not constitute advice Beneficiary to this Agreement will terminate upon notice if you do not constitute a.. Before your mobile number, ex: 19876543210, Precertification lists and CPT code search Tool obtained Ethnic, racial and linguistic needs easy administration ; pharmacy providers and APCN Networks. The content of this product is with Aetna, Inc. and no endorsement by AMA. 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