We have developed strict policies and procedures to protect member information including race, ethnicity and language preference information from inappropriate use and disclosure. Providers can receive the most effective, stress-free service. This information is neither an offer of coverage nor medical advice. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. The member's benefit plan determines coverage. Some subtypes have five tiers of coverage. Members also told us the assistance they received helped them better manage their health, We surveyed members in the Aetna Disease Management program. Applicable FARS/DFARS apply. Legal notices When expanded it provides a list of search options that will switch the search inputs to match the current selection. The IOQ will help service more individuals and families affected by autism and expand access to quality autism care. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. No fee schedules, basic unit, relative values or related listings are included in CPT. 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. NCQA will send you the handbook and application. NCQA Health Plan Accreditation is a widely recognized, evidence-based program dedicated to quality improvement and measurement. 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. Explore health plan accreditation with Wellsource. have relied on Wellsource for innovative, evidence-based, NCQA-certified health risk assessment solutions to 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. 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. NCQA's Health Plan Ratings 2024 include commercial, Medicare and Medicaid health plans. Obtain full pricing information by submitting a request through My NCQA. Interested in other accreditation options? Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 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. Health plans and accreditation status: Aetna Better Health of California Scheduled What is NCQA its history and key objectives? 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. We also work closely with numerous national health care organizations that have identified racial and ethnic disparities in health care as an issue that needs attention and action. 3.0. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. ncqa, CPT is a registered trademark of the American Medical Association. If you dont see what youre looking for below, you can search NCQAs database of additional common questionsor ask a question through My NCQA. 0000002094 00000 n
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Also, language and cultural barriers must be eliminated. Please be sure to add a 1 before your mobile number, ex: 19876543210. Applicable FARS/DFARS apply. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Condition-targeted health assessments for service line growth. HWmoH_1A^UIi+/i6W\I_qT5=3/d6@Z*'hUMfId9oqH$v
E$SG8Bo>m+w(;#ua\CVAZkY@]Ef^O?:SN9"},P:X%O{g=S<5po}#=tEWii*mF(b -.dD*Y5dmegs/kJ/1j-cv=p#eu|iBW.6Y56z 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. Performs functions addressed in the standards, either directly or through a service agreement. The certification process requires a substantial amount of time and resources including usability testing, documentation, and product review and enhancement. 0000001025 00000 n
The face of America's workforce is changing rapidly as our nation's population of ethnic and racial minorities continues to grow. 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. 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. If you are considering health plan accreditation, you have likely heard of theNational Committee for Quality Assurance(NCQA). As one of the nations leading health plans, Aetnas members represent the countrys increasing diversity in race, ethnicity and language. At least 9 months before desired survey start date: Begin the online application process. Reprinted with permission. For a healthcare organization to earn an NCQA Health Plan Accreditation, it is required to meet standards encompassing more than 100 measured elements. Copyright 2023 National Committee for Quality Assurance. The member's benefit plan determines coverage. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. For language services, please call the number on your member ID card and request an operator. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. We updated our app and provider directory to help members easily find providers who offer telemedicine. We created social media campaigns forLGBTQ and BIPOC youth. NCQA Accreditation for Population Health Program (PHP) November 28, 2022 - November 28, 2025 OptumHealth Care Solutions, LLC. If you are not currently accredited and want to learn more, contact NCQA. 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. CPT is a registered trademark of the American Medical Association. <<354B25B36AD9EC4CB456011F0DE50B5F>]>>
Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. It is only a partial, general description of plan or program benefits and does not constitute a contract. Links to various non-Aetna sites are provided for your convenience only. 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 . In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Its the only evaluation program that bases results on actual measurement of clinical performance (HEDIS measures) and consumer experience (CAHPS measures). NCQA Credentialing Accreditation assesses any organization that offers credentialing services to ensure the organization can maintain a superior network for its contracted clients. 0000007964 00000 n
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. Agreement and Collaboration With Clients. The first step to earning accreditation is a discussion with an NCQA program expert. Pricing is based on multiple factors. 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. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 0000018200 00000 n
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. All Rights Reserved. Align your organizations processes with the CR standards. Lets take a look at the benefits of going with a certified vendor in the example use case of using health risk assessments (HRAs). The Ultimate Guide to Health Risk Assessments, A Large Employer Realizes Over $85,000 in Direct ROI from the Wellsource HRA, Checklist: Choosing the Right Health Risk Assessment, If you are considering health plan accreditation, you have likely heard of the. Methodology 0000002520 00000 n
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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. It is only a partial, general description of plan or program benefits and does not constitute a contract. trailer /Size 49 /Info 8 0 R /Root 10 0 R /Prev 21523 /ID[060e888545013965100abd54e3afe5c1>060e888545013965100abd54e3afe5c1>] >> startxref 0 %%EOF 10 0 obj /Type . Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". 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. Patient-Centered Medical Home (PCMH) Health Plan Accreditation HEDIS Measures Health Innovation Summit Weve partnered with Psych Hub to offer a customized suicide prevention training and certification program to all contracted network behavioral health and EAP providers at no cost. 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. Submit an inquiry through My NCQA. 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. OTHER NAMES FOR THIS HEALTH PLAN. health risk assessment, The standards provide a framework for adopting industry best practices to accurately and efficiently credential and recredential health care professionalsensuring that medical organizations employ qualified professionals and align with state requirements. NCQA certification is a testament to a companys commitment to participant experience and scientific validity. 0000017970 00000 n
Obtain full pricing information by submitting a request through My NCQA. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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.
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