If calls persist, consider discussing certain scam blocking features with your phone company. Aetna handles premium payments through Payer Express, a trusted payment service. Some subtypes have five tiers of coverage. The Appointment of Representative form is on CMS.gov. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. If you have questions, you can message the dermatologist for seven days after youve received your plan. All fields marked with an asterisk (*) are required. 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. You cant trust caller id. This search will use the five-tier subtype. Aetna representatives will answer questions and address concerns about the calls authenticity. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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. [Narrator] Our quality providers are here for you 24/7/365. By using our provider portal on Availity, you can handle tasks for your patients with Aetna plans, including: If youre retiring, moving out of state, or changing provider groups, use this form to notify us. Scammers say you need to pay a fee for a new Medicare card or youll lose your Medicare coverage. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. The 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) for a particular member. Si tu intencin no era salir del sitio web, cierra este mensaje. 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. 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 information you will be accessing is provided by another organization or vendor. All services deemed "never effective" are excluded from coverage. Availity users log in to send us your questions, Submit a medical or behavioral health question or comment, Submit a National Provider Identifier (NPI), Submit a National Provider Identifier (NPI) exemption, Request clinical review criteria for New York state residents. Call us at 1-800-282-5366 ${tty} 7 days a week, 8 AM to 8 PM 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. 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. All Rights Reserved. Applicable FARS/DFARS apply. Copyright 2015 by the American Society of Addiction Medicine. The caller claims new cards from one of these agencies are in the works, and they need you to update your information on file. We're here to help. When billing, you must use the most appropriate code as of the effective date of the submission. 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. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. Care for minor illnesses, mental health and more. I practice independently and I want to contract with Aetna. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. WebContact Aetna Get the answers you need here If you have questions related to COVID-19, including those on our telemedicine policy, testing, coding for COVID-19 related visits, and additional resources Aetna is sharing to support you during this pandemic, please check our Provider COVID-19 FAQ website. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 1-866-235-5660${tty} Froma24-hour nurse line to vision and fitness, youre covered. 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 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). Any information we provide is limited to those plans we do offer in your area. *MinuteClinic in-person services are not included with this product and are subject to plan benefit. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. 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. [Narrator] It's care on your schedule at your convenience. The 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) for a particular member. Dual Eligible Special Needs Plans (D-SNP). By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. 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. If you do not intend to leave our site, close this message. 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. Treating providers are solely responsible for medical advice and treatment of members. Applicable FARS/DFARS apply. 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. As we develop more health problems, our risk score increases. 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. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. They do not have access For 2022, Aetna Medicare Advantage Prescription Drug (MAPD) plans earned an overall weighted average rating of 4.29 out of 5 stars. WebHMO and Medicare Advantage - 1-800-624-0756 (TTY: 711) Indemnity and PPO-based plans - 1-888-MD AETNA (1-888-632-3862) (TTY: 711) Voluntary plans - 1-888-772-9682 (TTY: 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. The 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) for a particular member. Health benefits and health insurance plans contain exclusions and limitations. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. Review the enrollment checklist with 4 to-do's before you choose a health plan. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Others have four tiers, three tiers or two tiers. It may be different from your Aetna secure member site log in. We received your request, and well get back to you shortly. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Treating providers are solely responsible for dental advice and treatment of members. To help us direct your question or comment to the correct area, please select a category below. We've got your back. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". It is only a partial, general description of plan or program benefits and does not constitute a contract. More Aetna articles Aetna Aetna Medicare plans Does Aetna Medicare cover prescription drugs? Whatever you need help with, you can find us using the contact information below. Access your health information, lab results and personalized tips from anywhere with your health dashboard. [Mom] I feel so much relief. Your benefits plan determines coverage. Health benefits and health insurance plans contain exclusions and limitations. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. If you do not intend to leave our site, close this message. Call 1-800-556-1555 (TTY: 711) anytime. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Members should discuss any matters related to their coverage or condition with their treating provider. The 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) for a particular member. 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. Come to a seminar to learn about Aetna Medicare plans and benefits. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Your Payer Express log-in may be different from your Aetna secure member site log-in. 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. All Rights Reserved. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 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. Dual Eligible Special Needs Plans (D-SNP). Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Medicare Helpline & Website Get general or claims-specific Medicare information, request documents in alternate formats and make changes to your Medicare 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.