Purchase and review the program resources, conduct a gap analysis and submit your online application. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. 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. Align your organizations processes with the CR standards. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Purchase and review the program resources, conduct a gap analysis and submit your online application. xbbbd`b``l $ u Checklist, The Top 3 Benefits of Health Risk Assessments, 3 Healthcare Marketing Trends Taking Center Stage in 2023. Establish a baseline representative of the demographic composition of Aetnas membership; and. 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. endstream endobj 69 0 obj <>/Size 45/Type/XRef>>stream The roadmap for improvement can include paying close attention to: The evaluation of these programs is based on clinical performance as well as consumer experience. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. trailer /Size 49 /Info 8 0 R /Root 10 0 R /Prev 21523 /ID[060e888545013965100abd54e3afe5c1>060e888545013965100abd54e3afe5c1>] >> startxref 0 %%EOF 10 0 obj /Type . Unlisted, unspecified and nonspecific codes should be avoided. 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. See Accreditation status and health plan rating for Aetna Health Inc. (New Jersey) on NCQA Report Cards. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Pricing is based on multiple factors. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. The member's benefit plan determines coverage. Download our case study to learn how vendors earn NCQA certification, and the value this recognition has brought toWellsourceclients for over a decade running. Workgroup Charter In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 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. 0000007519 00000 n 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. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Work with HealthHUB, MinuteClinic and Network to bring licensed clinical social workers in to stores and offer new services, such as life coaching. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. CPT is a registered trademark of the American Medical Association. *NCQA-Accredited health plans or MBHOs are eligible for Accreditation in UM, CR or PN if they also maintain health plan or MBHO Accreditation. You will be prompted to log in to your NCQA account. 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. 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). Eligible organizations: Note: A practitioner network is the practitioner network of clients and organizations. The NCQA bases its general accreditation fee on a formula of $39,750 plus 16 cents per member if the plan's membership is over 50,000. 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). Methodology Through the accreditation process, organizationsare able toperform a gap analysis and identify areas for improving their evidence-based practices. Satisfaction remained high, and members are likely to recommend the program. Data leads to insight about member health needs, which strengthens our ability to develop targeted initiatives. It is only a partial, general description of plan or program benefits and does not constitute a contract. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 0 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 number of sites is also factored in, so fees typically range from $40,000 to $100,000 for three-year accreditation. Providers can receive the most effective, stress-free service. 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). NCQA health plan accreditation is awidely-recognized, evidence-based program that works to ensure quality improvement and measurementthroughaligning organizations witha comprehensive framework. Some subtypes have five tiers of coverage. It is important to note that Aetna uses this information only to improve the quality of care for our members and not for rating, underwriting, determining insurability, marketing or premium determinations. 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 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. 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. Each main plan type has more than one subtype. NCQA Health Insurance Plan Ratings 2019-2020 - Detail Report (Private) Plan Name: Aetna Life Insurance Company (Ohio) Rating: 3.5. Your benefits plan determines coverage. Submit an inquiry through My NCQA. NCQA Confers Health Equity Accreditation on Elevance Health Medicaid Plans Aetna Medicaid Plan Recognized by NCQA for Health Equity Efforts UnitedHealthcare Grants Address Social Determinants of . 0000004213 00000 n ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Over 1,000 health plan products have earned NCQA Health Plan Accreditation. NCQA's Health Plan Ratings 2024 include commercial, Medicare and Medicaid health plans. Treating providers are solely responsible for dental advice and treatment of members. 3.0. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The AMA is a third party beneficiary to this Agreement. We take our NCQA accreditation seriously. %PDF-1.4 % See all legal notices We were the first health appraisal vendor to be certified by NCQA and have received certification continuously since 2008. health plans. Quality Compass is a registered trademark of NCQA. Operates under an insurance license (e.g., HMO, POS, PPO, EPO). In 2019, NCQA rated more than 1,000 health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. Notification to Authorities and Practitioner Appeal Rights. 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. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Satisfaction remained high, and members are likely to recommend the program. This workgroup will provide input on topics related to the standards and processes of requiring all MCPs to obtain NCQA accreditation, including consideration of the proposed accreditation requirements. No fee schedules, basic unit, relative values or related listings are included in CPT. Employers, in turn, will benefit from increased productivity, lower absenteeism and, possibly, lower health care cost increases. Credentialing and recredentialing processes. Provides services through an organized delivery system that includes ambulatory and inpatient health care sites. ,) V-Wz/"HESru66x k#1:1eM8Q g`$d(d|jJ\]7CY]h:tUf5u{;=== fJ*F=(W3OiLz}mLT EN"TPrr5[U1 UEpQ_(!`9%1pcrYfgNrLB,e~'usgg=E@gIU wFGfMK_* T@F2w\0t~Xx[J4pKqa}o* ]xqx03P^=NcjdU1al7%D2y'AL,,UB,b6 Download, NCQA If you dont see what youre looking for below, you can search NCQAs database of additional common questionsor ask a question through My NCQA. At the very least, patients must be given tools that help them to speak more confidently and effectively with their health care providers so that they can take greater control of their health and well-being. Contact Member Services Page last updated: January 25, 2023 Obtain full pricing information by submitting a request through My NCQA. Login. Develop robotics expertise and automated solutions for manual work and data entry. 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). 3 months before the survey start date: an Accreditation Services Coordinator from NCQA will contact your organization. Ratings emphasize care outcomes (the results of care) and what patients say about their care. Understand your population's health risks and improve health outcomes. 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. NCQA requirements are a roadmap for improvementorganizations use them to perform a gap analysis and align improvement activities with areas that are most important to states and employers, such as network adequacy and consumer protection. Members should discuss any matters related to their coverage or condition with their treating provider. NCQA Accreditation as of June 30, 2022. The rigor of this process is one way that accredited organizationscan signal theircommitmentto best practices and quality measures. URL: www.aetna.com. For language services, please call the number on your member ID card and request an operator. The following accreditation status can be found on the National Committee for Quality Assurance (NCQA) website. Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organizations survey readinessthe tool calculates your potential survey score. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Treating providers are solely responsible for dental advice and treatment of members. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 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. What is NCQA its history and key objectives? Together with Autism Comprehensive Educational Services (ACES), weve created the first Aetna Institute of Quality (IOQ) for autism. Need help with Medicare enrollment? You are now being directed to CVS Caremark site. health risk assessment, 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. Do you want to continue? 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. The information you will be accessing is provided by another organization or vendor. 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. Aetna Better health has implemented the following Credentialing process to meet NCQA Standards: NCQA is implementing the exceptions noted above for the March 1 -September 1, 2020, time frame. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Treating providers are solely responsible for medical advice and treatment of members. Our clinical activities and programs are based on proven guidelines. xref Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation. 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. 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. Here's what we did in 2021: Enhancing health and mental well-being leads to a better quality of life. The issue of health care disparities is immensely complex, but there are targeted solutions that can help us bridge the gap. Go to the American Medical Association Web site. The health plan worked with NCQA to help test the concepts and application of the accreditation. Interested in other accreditation options?Click hereto 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. Treating providers are solely responsible for medical advice and treatment of members. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Maintain Your License. If you dont see what youre looking for below, you can search NCQAs database of additional common questions for Medicare, Medicaid and commercial plans. NCQA Accreditation as of June 30, 2022. All Rights Reserved. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change.