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. 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). Please log in to your secure account to get what you need. NCQA Credentialing Accreditation is designed to ensure that organizations pursuing accreditation can maintain a high-quality network for members and contracted clients. ,) V-Wz/"HESru66x
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Contact Member Services Page last updated: January 25, 2023 Obtain full pricing information by submitting a request through My NCQA. A complete listing of health plans and their NCQA accreditation status can be found on the NCQA website located at No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. The AMA is a third party beneficiary to this Agreement. 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. 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). As described above, seeking accreditation is anarduous process. learn more URAC Accreditation for Health Call Center May 1, 2021 - May 1, 2024 Optum Serve Learn more Quality Compass is a registered trademark of NCQA. Together with Autism Comprehensive Educational Services (ACES), weve created the first Aetna Institute of Quality (IOQ) for autism. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). NCQA requirements are a roadmap for improvementorganizations use them to perform a gap analysis and align improvement activities with areas that are most important to states and employers, such as network adequacy and consumer protection. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. The NCQA bases its general accreditation fee on a formula of $39,750 plus 16 cents per member if the plan's membership is over 50,000. If you are currently accredited and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA. The first step to earning accreditation is a discussion with an NCQA program expert. NCQA certification is a testament to a companys commitment to participant experience and scientific validity. 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). If an organization allows its Accreditation status to lapse, its UM, CR or PN Accreditation status will remain in place but may not be renewed. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. How do I get NCQA certified? More than 90 organizations have earned NCQA Credentialing Accreditation. Certain races and ethnicities encounter certain diseases and conditions at higher rates. 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. FAQs - Health Plan Accreditation - NCQA Contact us Get member help Aetna members have access to contact information and resources specific to their plans. Kristine works at Ncqa as Assistant Vice President of State Affairs. Satisfaction remained high, and members are likely to recommend the program. Search for Medicare Plans - NCQA Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. 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? Unlisted, unspecified and nonspecific codes should be avoided. More than 1,000health plans have earnedNCQA Accreditation and achieving accreditation is a lengthy process, representing a lot of work. 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. It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers. xref
For language services, please call the number on your member ID card and request an operator. 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. CVS Health Receives NCQA Utilization Management Accreditation RESOURCES FOR HEALTH PLANS. Patient-Centered Medical Home (PCMH) Recognition 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. The member's benefit plan determines coverage. Save your favorite pages and receive notifications whenever theyre updated. Private Health Insurance Plan Ratings - NCQA If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Enter the email address you signed up with and we'll email you a reset link. 0000018200 00000 n
CPT is a registered trademark of the American Medical Association. Your benefits plan determines coverage. 0000001756 00000 n
This Agreement will terminate upon notice if you violate its terms. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. If you are not currently accredited and want to learn more, contact 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. Asthma drug management Did people, . Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 0000004583 00000 n
CPT only copyright 2015 American Medical Association. 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. So why do health plans do it? Each main plan type has more than one subtype. 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. Over 1,350 providers have enrolled with a 61% course completion rate. Aetna Better Health of New Jersey. Data leads to insight about member health needs, which strengthens our ability to develop targeted initiatives. NCQA Accreditation for Population Health Program (PHP) November 28, 2022 - November 28, 2025 OptumHealth Care Solutions, LLC. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. 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. <<354B25B36AD9EC4CB456011F0DE50B5F>]>>
Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Is UPMC A Medicaid Plan? | Insurance Guide Treating providers are solely responsible for dental advice and treatment of members. How Do I Get Credentialed With United? | Insurance Guide Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. NCQA's Health Plan Ratings 2022. Additionally, racial and ethnic information is important to a persons health plan. Below are some of the most frequently asked questions about NCQA Credentialing Accreditation.
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. Create and deliver quality improvement, management or assessment programs and processes. The typical evaluation time frame is 12 months from application submission to decision, depending on an organizations readiness. Treating providers are solely responsible for medical advice and treatment of members. Purchase and review the program resources, conduct a gap analysis and submit your online application. We do not share your information with third parties. 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. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. It's how we show our commitment to improving your quality of care, access to care and member satisfaction. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. More people are using telemedicine. Applicable FARS/DFARS apply. Unlisted, unspecified and nonspecific codes should be avoided. Credentialing and recredentialing processes. We have developed strict policies and procedures to protect member information including race, ethnicity and language preference information from inappropriate use and disclosure. 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 certification process requires a substantial amount of time and resources including usability testing, documentation, and product review and enhancement. All Rights Reserved. and achieving accreditation is a lengthy process, representing a lot of work. For example, we work with groups of doctors and other health professionals to make health care better. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. The review process is rigorous and may consist of both an onsite and offsite evaluation. 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. and Compliance, Evidence-Based 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. The number of sites is also factored in, so fees typically range from $40,000 to $100,000 for three-year accreditation. Employers, in turn, will benefit from increased productivity, lower absenteeism and, possibly, lower health care cost increases.