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. 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 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. REPORT CARDS. For example, we work with groups of doctors and other health professionals to make health care better. 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. 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. Such data can lead to the development of specific initiatives that improve the health of people of various backgrounds based on their risks for certain conditions. Purchase and review the program resources, conduct a gap analysis and submit your online application. 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. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Success of our initiatives will be achieved if we can: In the end, true success will come when our members achieve improved health outcomes as a result of our targeted initiatives and programs. We were the first health appraisal vendor to be certified by NCQA and have received certification continuously since 2008. Obtain full pricing information by submitting a request through My NCQA. Health benefits and health insurance plans contain exclusions and limitations. Lets take a look at the benefits of going with a certified vendor in the example use case of using health risk assessments (HRAs). NCQA will send you the handbook and application. 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. 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. Our quality improvement program helps improve the behavioral health care we provide to you. 0000004063 00000 n 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. NCQA health plan accreditation is a widely-recognized, evidence-based program that works to ensure quality improvement and measurement through aligning organizations with a comprehensive framework. Cost: $449 Date: Wednesday, September 14, 2022; 1-4pm ET NCQA Health Equity Accreditation Plus. 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. NCQA Health Plan Accreditation is a widely recognized, evidence-based program dedicated to quality improvement and measurement. Star ratings were created to help beneficiaries assess their care needs against the quality of Medicare Advantage health plans care and service. NCQA's Health Equity Accreditation Plus helps health care organizations that have implemented core Health Equity Accreditation activities establish processes and cross-sector partnerships that identify and address social risk factors in their communities and the social needs of the people they serve. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Treating providers are solely responsible for medical advice and treatment of members. 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. 0000001756 00000 n Purchase and review the program resources, conduct a gap analysis and submit your online application. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. \t_=)@S. Please be sure to add a 1 before your mobile number, ex: 19876543210. Methodology 0000001025 00000 n Kristine is based out of Ventura County, California, United States and works in the Hospitals and Health Care industry. 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). Detailed Health Insurance Plan Ratings for Aetna Better Health Inc., a Pennsylvania Corporation from 2019 - 2020 . Analytical, Diagnostic and Therapeutic Techniques and Equipment 41. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Develop robotics expertise and automated solutions for manual work and data entry. Has a process for monitoring, evaluating and improving the quality and safety of care provided to its members, Reports audited HEDIS results for designated HEDIS. Build vs. Buy: Which Health Risk Assessment Approach is Right for You. The ABA Medical Necessity Guidedoes not constitute medical advice. ncqa, 0000004213 00000 n You will be prompted to log in to your NCQA account. Over 1,350 providers have enrolled with a 61% course completion rate. 0000001781 00000 n Save your favorite pages and receive notifications whenever theyre updated. Who do we contact to begin credentialing with UnitedHealthcare or its affiliates? Go to the American Medical Association Web site. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Disclaimer of Warranties and Liabilities. Develop preventive health, early detection and disease management programs and processes. RESOURCES FOR HEALTH PLANS. As one of the nations leading health plans, Aetnas members represent the countrys increasing diversity in race, ethnicity and language. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Applicable FARS/DFARS apply. NCQA Credentialing Accreditation is a comprehensive program that evaluates the operations of organizations providing full-scope credentialing services, which include verifying practitioner credentials, designated credentialing-committee review of practitioners and monitoring practitioner sanctions. 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. Links to various non-Aetna sites are provided for your convenience only. 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 number of sites is also factored in, so fees typically range from $40,000 to $100,000 for three-year accreditation. 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. Download our case study to learn how vendors earn NCQA certification, and the value this recognition has brought toWellsourceclients for over a decade running. 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. 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). 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 note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Programs like the National Committee for Quality Assurance (NCQA) Health Plan Accreditation rely on CAHPS to measure Medicare star ratings. We launched our Caring Contacts program to provide resources and support to Aetna members discharged from an inpatient setting after a suicide attempt. NCQA Accreditation for Population Health Program (PHP) November 28, 2022 - November 28, 2025 OptumHealth Care Solutions, LLC. 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. Others have four tiers, three tiers or two tiers. Please note that NCQA does not endorse MCG Health's solutions, or require the use of MCG care guidelines to achieve accreditation. The accreditations come after Aetna Better Health of Michigan, Inc., participated in an eight-month NCQA sponsored pilot to develop its Health Equity Accreditation Plus evaluation program. An organization that earns Accreditation meets standards covering more than 100 measured elements. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. 0000002555 00000 n 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. 2 Based on results from the 2021 Aetna Disease Management Member Satisfaction Analysis. 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). 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. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". 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. 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. 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. Specifically, Aetna uses information our members voluntarily provide to: Yes. *NCQA-Accredited health plans or MBHOs are eligible for Accreditation in UM, CR or PN if they also maintain health plan or MBHO Accreditation. The member's benefit plan determines coverage. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 0000001192 00000 n Applicable FARS/DFARS apply. 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. All Rights Reserved. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members.

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