In case of a conflict between your plan documents and this information, the plan documents will govern. 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). Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation. NCQA is ready to help! Measure the performance and outcomes of our programs and processes. Develop preventive health, early detection and disease management programs and processes. 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). Need help with Medicare enrollment? See Accreditation status and health plan rating for Aetna Health Inc. (New Jersey) on NCQA Report Cards. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Condition-targeted health assessments for service line growth. 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. Explore health plan accreditation with Wellsource. Copyright 2023 National Committee for Quality Assurance. %%EOF
Create and deliver quality improvement, management or assessment programs and processes. Purchase and review the program resources, conduct a gap analysis and submit your online application. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. kBtUp+v;J~)k>x@4l1%RuMALe0>6L(h(yI
nL`suT;,y=PO#f{{0!4H6ISwB1"`rX`\'J$tS Standards recognize that organizations that apply for accreditation have open access networks, and can improve service quality and utilize customized structures to meet purchaser needs. Health (9 days ago) WebNCQA's Health Plan Ratings 2022 include commercial, Medicare, and Medicaid health plans. We shared the results with the National Committee for Quality Assurance (NCQA) Quality Compass. Treating providers are solely responsible for medical advice and treatment of members. 0000004063 00000 n
Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. OTHER NAMES FOR THIS HEALTH PLAN. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. More than 1,000 health plans have earned NCQA Accreditation and achieving accreditation is a lengthy process, representing a lot of work. NCQA Credentialing Accreditation assesses any organization that offers credentialing services to ensure the organization can maintain a superior network for its contracted clients. Explore health plan accreditation with Wellsource. 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. Login. Patient-Centered Medical Home (PCMH) Recognition 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. Work with HealthHUB, MinuteClinic and Network to bring licensed clinical social workers in to stores and offer new services, such as life coaching. You are now being directed to CVS Caremark site. Health benefits and health insurance plans contain exclusions and limitations. Build vs. Buy: Which Health Risk Assessment Approach is Right for You. NCQA Reviews the Application. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Wellsourceis a certified vendor with NCQA. The information you will be accessing is provided by another organization or vendor. Hear about our goals, the progress were making and how were tracking our efforts. 0000000816 00000 n
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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The health plan worked with NCQA to help test the concepts and application of the accreditation. Aetna Health Inc. . Certification, Readiness health plans, Don Hall, DrPH, CHES, Founder
Health Standards, Data Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. At least 9 months in advance: Conduct an analysis comparing current processes to NCQA requirements and adjust as necessary. This information is neither an offer of coverage nor medical advice. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Our provider network increased 6% in 2021. Credentialing Accreditation assesses an organizations performance in the following areas: Find the Standards and Guidelines document in the NCQA Store. Terms of Use, Patient-Centered Specialty Practice (PCSP), Credentials Verification Organization (CVO), Managed Behavioral Healthcare Organization (MBHO), Health Information Technology Prevalidation Programs, Virtual Seminars, Webinars and On-demand Training, Advertising and Marketing Your NCQA Status, database of additional common questions for Medicare, Medicaid and commercial plans, Use the NCQA Health Plan Accreditation standards to perform a gap analysis and determine improvement areas. trailer /Size 49 /Info 8 0 R /Root 10 0 R /Prev 21523 /ID[060e888545013965100abd54e3afe5c1>060e888545013965100abd54e3afe5c1>] >> startxref 0 %%EOF 10 0 obj /Type . We do not share your information with third parties. Submit an inquiry through My NCQA. learn more URAC Accreditation for Health Call Center May 1, 2021 - May 1, 2024 Optum Serve Learn more In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. The ABA Medical Necessity Guidedoes not constitute medical advice. Links to various non-Aetna sites are provided for your convenience only. Satisfy state requirements and employer needs. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Links to various non-Aetna sites are provided for your convenience only. hbspt.cta._relativeUrls=true;hbspt.cta.load(3949674, '00e7b261-db89-4360-9393-9d0dda543729', {"useNewLoader":"true","region":"na1"}); Tags: Together with Autism Comprehensive Educational Services (ACES), weve created the first Aetna Institute of Quality (IOQ) for autism. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Methodology underwritten by Aetna Life Insurance Company (Aetna). Notification to Authorities and Practitioner Appeal Rights. Credentialing and recredentialing processes. Accreditations See our recognition from trade associations, regulatory agencies and other governing bodies. Links to various non-Aetna sites are provided for your convenience only. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. Aetna has taken a leadership role in finding and implementing solutions to the problem of health care disparities and for 10 years has been a catalyst for change. Align your organization's processes with the CR standards. 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. trailer
NCQA Accreditation Earning NCQA's Accreditation of Case Management for LTSS demonstrates that an organization is dedicated to coordinating the delivery of care in a person-centered and integrated manner to help individuals function optimally in their preferred setting. 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). health plans. NCQA Accreditation as of June 30, 2022. You will be prompted to log in to your NCQA account. More than 1,000health plans have earnedNCQA Accreditation and achieving accreditation is a lengthy process, representing a lot of work. 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. endstream
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Kristine works at Ncqa as Assistant Vice President of State Affairs. To improve satisfaction, we: Improved the accuracy of our provider directory information, Improved online self-service options for members and providers, We surveyed members in the Aetna Case Management program. We are committed to improving services for preventive health, early detection and disease management for health conditions commonly seen in specific racial or ethnic groups. 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). 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. Certain races and ethnicities encounter certain diseases and conditions at higher rates. At least 9 months before desired survey start date: Begin the online application process. We also give you and your doctors information and tools that can help you make decisions. Call a licensed agent at 1-855-335-1407 (TTY: 711) , 7 days a week, 8 AM to 8 PM. 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. Its the only evaluation program that bases results on actual measurement of clinical performance (HEDIS measures) and consumer experience (CAHPS measures). Go to the American Medical Association Web site. The rigor of this process is one way that accredited organizationscan signal theircommitmentto best practices and quality measures. Download, NCQA Analytical, Diagnostic and Therapeutic Techniques and Equipment 41. Save your favorite pages and receive notifications whenever theyre updated. 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. 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. Reprinted with permission. 0000018406 00000 n
Please log in to your secure account to get what you need. Medi-Cal Managed Care Health Plan (MCP) Accreditation Status August 2019. Help gain accreditation by the National Committee for Quality Assurance (NCQA) and other accreditation organizations. Who do we contact to begin credentialing with UnitedHealthcare or its affiliates? (The industry standard is 10 to 20%.). Visit the secure website, available through www.aetna.com, for more information. 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. Purchase and review the program resources, conduct a gap analysis and submit your online application. Visit the secure website, available through www.aetna.com, for more information. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. 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. 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. Share this page with a friend or colleague by Email. (NCQA). Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Assess Aetna's health care provider networks' ability to meet race, ethnicity, culture and language communication needs and preferences of our member population. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 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. ages 5 to 64, with persistent asthma have an appropriate ratio of asthma medications to help control their symptoms? 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. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. An organization that earns Accreditation meets standards covering more than 100 measured elements. 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. 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. Purchase and review the program resources, conduct a gap analysis and submit your online application. Pricing is based on multiple factors. In case of a conflict between your plan documents and this information, the plan documents will govern. NCQA conducts the survey and determines your accreditation status within 30 days of the final review. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. What makes for an engaging health and wellness program? The typical evaluation time frame is 12 months from application submission to decision, depending on an organizations readiness. Some organizations may already be working within NCQA guidelines. The first step to earning accreditation is a discussion with an NCQA program expert. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. NCQA Utilization Management Accreditation is a quality assessment program that focuses on consumer protection and customer service improvement. Aetna Student Health is the brand name for products and services provided by Aetna Life Insurance Company and its applicable affiliated companies (Aetna). 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Aetna Better Health of New Jersey. How do I credential with UnitedHealthcare? 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.