In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 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. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). The typical evaluation time frame is 12 months from application submission to decision, depending on an organizations readiness. Need help with Medicare enrollment?
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). PDF National Medicaid - Quality Management Accreditation COMMUNICATION - Aetna Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Login. Some organizations may already be working within NCQA guidelines. Accreditation and Regulation: Can They Help Improve Patient Safety? Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 2 Based on results from the 2021 Aetna Disease Management Member Satisfaction Analysis. Treating providers are solely responsible for medical advice and treatment of members. For over 40 years, health plans, wellness organizations, and companies committed to improving health outcomes 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. If DHCS required NCQA accreditation and followed the 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 . Obtain full pricing information by submitting a request through My NCQA. 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. 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. Please log in to your secure account to get what you need. No fee schedules, basic unit, relative values or related listings are included in CPT. The member's benefit plan determines coverage. Download, NCQA Please log in to your secure account to get what you need. Health Standards, Data 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. Certain races and ethnicities encounter certain diseases and conditions at higher rates. Legal notices Members should discuss any matters related to their coverage or condition with their treating provider. Is UPMC A Medicaid Plan? | Insurance Guide We piloted new programs to help members manage addiction, depression, anxiety and eating disorders. NCQA > Certification - National Committee for Quality Assurance It is only a partial, general description of plan or program benefits and does not constitute a contract. The member's benefit plan determines coverage. 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. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. CPT is a registered trademark of the American Medical Association. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Your benefits plan determines coverage. Aetna Better Health of Michigan, Inc., earns NCQA Health Equity And for good reason if it were easy, just anyone could do it. Some subtypes have five tiers of coverage. Its the only evaluation program that bases results on actual measurement of clinical performance (HEDIS measures) and consumer experience (CAHPS measures). Our Accreditations | Optum NCQA Health Equity Accreditation: Impact and Benefits The first step to earning accreditation is a discussion with an NCQA program expert. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Specifically, Aetna uses information our members voluntarily provide to: Yes. 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. Unlisted, unspecified and nonspecific codes should be avoided. 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. CPT only copyright 2015 American Medical Association. The member's benefit plan determines coverage. 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 0000000816 00000 n
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. Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation. NCQA accreditation or interim accreditation, while an additional six MCPs are in the process of achieving accreditation; that is 18 of 24 currently contracted MCPs. kBtUp+v;J~)k>x@4l1%RuMALe0>6L(h(yI
nL`suT;,y=PO#f{{0!4H6ISwB1"`rX`\'J$tS Aetna is committed to Accreditation by the National Committee for Quality Assurance (NCQA) as a means of demonstrating a commitment to continuous quality improvement and meeting customer expectations. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Kristine Toppe - Assistant Vice President of State Affairs at Ncqa - Wiza Issues a contract for insurance for a defined population or contracts with an employer to provide managed care services for a self-insured population. The NCQA makes the results public. Health Care Accreditation, Health Plan Accreditation Organization - NCQA - NCQA The National Committee for Quality Assurance (NCQA) exists to improve the quality of health care. 0000013951 00000 n
CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. \t_=)@S. Data leads to insight about member health needs, which strengthens our ability to develop targeted initiatives. Align your organizations processes with the standards. No fee schedules, basic unit, relative values or related listings are included in CPT. 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. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. READ SOMETHING ELSE NCQA Accreditation helps health plans demonstrate their commitment to quality and accountability and provides extraordinary benefits in today's market. 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. 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. xbbbd`b``l $ u
to Fuel Marketing initiatives, Scale Copyright 2023 National Committee for Quality Assurance. Performs functions addressed in the standards, either directly or through a service agreement. Learn about our efforts and how far weve come. 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. Quality Compass is a registered trademark of NCQA. Quality Management & Improvement Efforts | Aetna Medicare and achieving accreditation is a lengthy process, representing a lot of work. 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. We launched our Caring Contacts program to provide resources and support to Aetna members discharged from an inpatient setting after a suicide attempt. Please be sure to add a 1 before your mobile number, ex: 19876543210.