Pricing is based on multiple factors. Save your favorite pages and receive notifications whenever theyre updated. 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. NCQA Credentialing Accreditation assesses any organization that offers credentialing services to ensure the organization can maintain a superior network for its contracted clients. 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 member's benefit plan determines coverage. 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. ncqa, And for good reason if it were easy, just anyone could do it. 0000001935 00000 n Explore health plan accreditation with Wellsource. 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. 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. The ABA Medical Necessity Guidedoes not constitute medical advice. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 12 months in advance: Become familiar with NCQA's required standards and processes. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Please note that NCQA does not endorse MCG Health's solutions, or require the use of MCG care guidelines to achieve accreditation. OTHER NAMES FOR THIS HEALTH PLAN. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Call a licensed agent at 1-855-335-1407 (TTY: 711) , 7 days a week, 8 AM to 8 PM. Thankfully, NCQA has streamlined part of the process through its vendor certification program, in which vendors can be vetted for quality by NCQA, see the full directory of approved vendors and accredited organizations here. Please be sure to add a 1 before your mobile number, ex: 19876543210. Go to the American Medical Association Web site. NCQA certification is a testament to a companys commitment to participant experience and scientific validity. As a result, many MCPs already follow NCQA guidelines with regard to care coordination or population health management. The standardized survey process for plans of all types is constantly fine-tuned to keep pace with the changing health care environment. NCQA will send you the handbook and application. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. The member's benefit plan determines coverage. 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. Some subtypes have five tiers of coverage. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Submit the Application and Pay the Application Fee. 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). Companies use NCQA-certified HRAs and self-management tools because they know they provide quality data and a quality experience for the individuals who take them. Hear about our goals, the progress were making and how were tracking our efforts. 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 . 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. New and revised codes are added to the CPBs as they are updated. See the NCQA Report Card for a directory of accredited organizations. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. I am a results-driven Health Services professional with over 15 years of experience in Collecting, Organizing, Interpreting, Disseminating various types of data, Project/Program Management . The following accreditation status can be found on the National Committee for Quality Assurance (NCQA) website. Agreement and Collaboration With Clients. 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. 0000002555 00000 n If you dont see what youre looking for below, you can search NCQAs database of additional common questions for Medicare, Medicaid and commercial plans. 70 0 obj <>stream All Rights Reserved. Align your organizations processes with the standards. Treating providers are solely responsible for dental advice and treatment of members. No fee schedules, basic unit, relative values or related listings are included in CPT. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. 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. to Change Data, Security Over 1,350 providers have enrolled with a 61% course completion rate. It is only a partial, general description of plan or program benefits and does not constitute a contract. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. CPT is a registered trademark of the American Medical Association. Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organizations survey readinessthe tool calculates your potential survey score. Wellsource, Topics: Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Others have four tiers, three tiers or two tiers. Links to various non-Aetna sites are provided for your convenience only. Share this page with a friend or colleague by Email. Workgroup Charter The member's benefit plan determines coverage. 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. Satisfaction remained high, and members are likely to recommend the program. This search will use the five-tier subtype. URL: www.aetna.com. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The AMA is a third party beneficiary to this Agreement. 0000018200 00000 n This search will use the five-tier subtype. 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. Please expect to purchase texas premier hmo and health insurance providers texas health. Credentialing Accreditation assesses an organizations performance in the following areas: Find the Standards and Guidelines document in the NCQA Store. 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. Do you want to continue? More than 1,000 health plans have earned NCQA Accreditation and achieving accreditation is a lengthy process, representing a lot of work. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Were working hard to improve the service, quality and safety of health care. xref 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. Wellsource:NCQA Certified, Committed toQuality andExcellence, Ready to learn more about the NCQA certification process? 2 Based on results from the 2021 Aetna Disease Management Member Satisfaction Analysis. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. We launched our Caring Contacts program to provide resources and support to Aetna members discharged from an inpatient setting after a suicide attempt. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Satisfaction remained high, and members are likely to recommend the program. Health plan accreditation requires the use of HRAs and self-management toolsand though organizations seeking accreditation can opt to build their own HRA or partner with a third-party for the solution, many find themselves weighing the pros and cons of building their own solution and opting instead to partner with a trustworthy vendor. Program Evaluation Treatment Outcome Questionnaires Models, Organizational Health Care Surveys Pilot Projects Data Collection Prospective Studies Reproducibility of Results Electronic Health Records Retrospective Studies Cross-Sectional Studies Research Design Follow-Up Studies Ambulatory Care Interviews as Topic Feasibility . For language services, please call the number on your member ID card and request an operator. Efforts to reduce disparities in health care could ultimately improve care and reduce overall health care costs. We worked with BrandWatch to get social media analysis of mental health findings for adolescents and LGBTQ/BIPOC youth. If you dont see what youre looking for below, you can search NCQAs database of additional common questionsor ask a question through My NCQA. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice.
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