Others have four tiers, three tiers or two tiers. 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 . Enter the email address you signed up with and we'll email you a reset link. You are now being directed to CVS Caremark site. Eligible organizations: Note: A practitioner network is the practitioner network of clients and organizations. health plans, Don Hall, DrPH, CHES, Founder If you are not currently accredited and want to learn more, contact NCQA. 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. Your benefits plan determines coverage. More than 173 million people are enrolled in NCQA-Accredited health plans. The first step to earning accreditation is a discussion with an NCQA program expert. When billing, you must use the most appropriate code as of the effective date of the submission. Download our case study to learn how vendors earn NCQA certification, and the value this recognition has brought toWellsourceclients for over a decade running. At least 9 months in advance: Conduct an analysis comparing current processes to NCQA requirements and adjust as necessary. Recognition, Download No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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. An organization that earns Accreditation meets standards covering more than 100 measured elements. Do you want to continue? PDF We offer quality health plans - Aetna We launched an evidence-based 12-week pilot program with OUI Therapeutics/Vita Health for adults 18+ delivered virtually by clinical specialists to help lower suicide risk. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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. If you dont see what youre looking for below, you can search NCQAs database of additional common questions for Medicare, Medicaid and commercial plans. 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 be sure to add a 1 before your mobile number, ex: 19876543210. CPT only Copyright 2022 American Medical Association. 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). 0000014217 00000 n Links to various non-Aetna sites are provided for your convenience only. NCQA surveys require six months of data, so by the time you're six months away from your survey's start date, you should be fully compliant with NCQA standards. 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). 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. 0000004213 00000 n Disclaimer of Warranties and Liabilities. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. All services deemed "never effective" are excluded from coverage. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). If you dont see what youre looking for below, you can search NCQAs database of additional common questionsor ask a question through My NCQA. Accreditation Status of Health Plans Report - California All Rights Reserved. NCQA is ready to help! The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. NCQA Credentialing Accreditation assesses any organization that offers credentialing services to ensure the organization can maintain a superior network for its contracted clients. Aetna Life Insurance Company (Missouri) - NCQA Report Cards 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. Notification to Authorities and Practitioner Appeal Rights. Please log in to your secure account to get what you need. Organizations that earn a seal from NCQA show that they are serious about quality health care. Request an application. CPT only copyright 2015 American Medical Association. 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. Quality Compass is a registered trademark of NCQA. We shared the results with the National Committee for Quality Assurance (NCQA) Quality Compass. We created social media campaigns forLGBTQ and BIPOC youth. NCQA accreditation standards help health plans and other organizations align future initiatives with issues that are front and center for employers and states. It is important to note that Aetna uses this information only to improve the quality of care for our members and not for rating, underwriting, determining insurability, marketing or premium determinations. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Assess Aetna's health care provider networks' ability to meet race, ethnicity, culture and language communication needs and preferences of our member population. I = Insufficient data; NC = No Credit; NA = Not Applicable . NCQA Accreditation helps health plans demonstrate their commitment to quality and accountability and provides extraordinary benefits in today's market. This accreditation is the latest endorsement that Aetna has received from the NCQA for its products or programs. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". 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. Medi-Cal Managed Care Health Plan (MCP) Accreditation Status August 2019. 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. 0000007741 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. 0000017970 00000 n Your benefits plan determines coverage. Our quality improvement program helps improve the behavioral health care we provide to you. underwritten by Aetna Life Insurance Company (Aetna). What is NCQA behavioral health? [FAQs!] - wellbeingport.com 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 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. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. endstream endobj 46 0 obj <>/Metadata 5 0 R/PieceInfo<>>>/Pages 4 0 R/PageLayout/OneColumn/StructTreeRoot 7 0 R/Type/Catalog/Lang( E N - U S)/LastModified(D:20091014145733)/PageLabels 2 0 R>> endobj 47 0 obj <>/Font<>/ProcSet[/PDF/Text]/ExtGState<>>>/Type/Page>> endobj 48 0 obj [49 0 R] endobj 49 0 obj <>/A 57 0 R/F 4/H/I/StructParent 1/Border[0 0 0]/Type/Annot>> endobj 50 0 obj <> endobj 51 0 obj <> endobj 52 0 obj [/ICCBased 58 0 R] endobj 53 0 obj <>stream 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). What are the NCQA accreditation levels? - TeachersCollegesj xbbbd`b``l $ u 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). FAQs - Credentialing - NCQA 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. The National Committee for Quality Assurance's (NCQA) Diabetes Recognition Program (DRP) recognizes clinicians who have met standards demonstrating delivery of high-quality care to patients with diabetes. Obtain full pricing information by submitting a request through My NCQA. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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 have questions about a Med Premier major medical plan, call The Boon Group at the toll-free number on your member ID card. It's how we show our commitment to improving your quality of care, access to care and member satisfaction. If DHCS required NCQA accreditation and followed the This information is neither an offer of coverage nor medical advice. 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. 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). 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. Through the accreditation process, organizationsare able toperform a gap analysis and identify areas for improving their evidence-based practices. Credentialing services include: Verifying healthcare provider credentials through a primary source or a contracted agent of the primary source. NCQA certification is a testament to a companys commitment to participant experience and scientific validity. Pricing is based on multiple factors. 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. NCQA Health Equity Accreditation: Impact and Benefits Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. health plans. 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. We work for better health care, better choices and better health. Find opportunities to ensure equitable access to health care. Call a licensed agent at 1-855-335-1407 (TTY: 711) , 7 days a week, 8 AM to 8 PM. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 0000004063 00000 n 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. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 2 Based on results from the 2021 Aetna Disease Management Member Satisfaction Analysis. This button displays the currently selected search type. 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. CPT only copyright 2015 American Medical Association. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Open Choice PPO, Aetna Select, Elect Choice EPO, OA Elect Choice EPO, Open Access Aetna Select NCQA Accreditation as of June 30, 2022 I = Insufficient data; NC = No Credit; NA = Not Applicable Contact us at My.NCQA to ask about licensing the ratings data for research or display. 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. How do I credential with UnitedHealthcare? Search for Medicare Plans - NCQA
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