If you dont see what youre looking for below, you can search NCQAs database of additional common questionsor ask a question through My NCQA. Were working hard to improve the service, quality and safety of health care. Certification, Readiness 3 months before the survey start date: an Accreditation Services Coordinator from NCQA will contact your organization. 0000007741 00000 n LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). It is only a partial, general description of plan or program benefits and does not constitute a contract. to Fuel Marketing initiatives, Scale 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. Organizations that earn a seal from NCQA show that they are serious about quality health care. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Thankfully, NCQA has streamlined part of the process through its vendor certification program, in which vendors can be vetted for quality by NCQAsee the full directory of approved vendors and accredited organizations here. 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. Measure the performance and outcomes of our programs and processes. Treating providers are solely responsible for dental advice and treatment of members. Wellsourceis a certified vendor with NCQA. Treating providers are solely responsible for medical advice and treatment of members. Kristine works at Ncqa as Assistant Vice President of State Affairs. All Rights Reserved. 0000002555 00000 n 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. Develop robotics expertise and automated solutions for manual work and data entry. We were the first health appraisal vendor to be certified by NCQA and have received certification continuously since 2008. Patient-Centered Medical Home (PCMH) Health Plan Accreditation HEDIS Measures Health Innovation Summit NCQA's Health Plan Ratings 2022. See the NCQA Report Card for a directory of accredited organizations. As a result, many MCPs already follow NCQA guidelines with regard to care coordination or population health management. underwritten by Aetna Life Insurance Company (Aetna). You will be prompted to log in to your NCQA account. Standards recognize that organizations that apply for accreditation have open access networks, and can improve service quality and utilize customized structures to meet purchaser needs. 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). 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. 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. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. ? fZ IgBL- !|\W$D)8 F-JnvNzhkQOC6YSB~ O kk*t0pe]5{NLahbFs[q}dPm42iMUV%)) Satisfaction remained high, and members are likely to recommend the program. The health plan worked with NCQA to help test the concepts and application of the accreditation. NCQA Credentialing Accreditation is designed to ensure that organizations pursuing accreditation can maintain a high-quality network for members and contracted clients. Ratings emphasize care outcomes (the results of care) and what patients say about their care. CPT only copyright 2015 American Medical Association. health risk assessment, 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). And for good reason if it were easy, just anyone could do it. learn more URAC Accreditation for Health Call Center May 1, 2021 - May 1, 2024 Optum Serve Learn more Interested in other accreditation options?Click hereto learn more about how Wellsource products help organizations prove to accrediting bodies that their programs can measure health risks, segment and stratify populations, target interventions, and provide health education and self-management tools. 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. This information is neither an offer of coverage nor medical advice. 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. Credentialing and recredentialing processes. Understand your population's health risks and improve health outcomes. 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. We collected data on a set of clinical measures called Healthcare Effectiveness Data and Information Set (HEDIS), as applicable. Links to various non-Aetna sites are provided for your convenience only. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Legal notices All Rights Reserved. We do not share your information with third parties. 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 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). Align your organization's processes with the CR standards. Save your favorite pages and receive notifications whenever theyre updated. 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. Programs like the National Committee for Quality Assurance (NCQA) Health Plan Accreditation rely on CAHPS to measure Medicare star ratings. 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 Some organizations may already be working within NCQA guidelines. For language services, please call the number on your member ID card and request an operator. For example, we work with groups of doctors and other health professionals to make health care better. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. 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. In the past, health plans like Aetna have not systematically collected data on race and ethnicity. 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). 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. Aetna Health Inc. . 0000002520 00000 n NCQA Credentialing Accreditation means that the caliber of the CVO's credentialing process is first-class. 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. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The typical evaluation time frame is 12 months from application submission to decision, depending on an organizations readiness. trailer /Size 49 /Info 8 0 R /Root 10 0 R /Prev 21523 /ID[060e888545013965100abd54e3afe5c1>060e888545013965100abd54e3afe5c1>] >> startxref 0 %%EOF 10 0 obj /Type . Specifically, Aetna uses information our members voluntarily provide to: Yes. kBtUp+v;J~)k>x@4l1%RuMALe0>6L(h(yI nL`suT;,y=PO#f{{0!4H6ISwB1"`rX`\'J$tS Simply call UnitedHealthcare at 877-842-3210, say or enter your tax identification number (TIN), and then say, as prompted, Other Professional Services > Credentialing > Medical > Join the Network.. How long does it take to be credentialed with UnitedHealthcare? Health plans and accreditation status: Aetna Better Health of California Scheduled Copyright 2023 National Committee for Quality Assurance. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Your benefits plan determines coverage. Detailed Health Insurance Plan Ratings for Aetna Better Health Inc., a Pennsylvania Corporation from 2019 - 2020 . Recognition, Download Efforts to reduce disparities in health care could ultimately improve care and reduce overall health care costs. See Accreditation status and health plan rating for Aetna Health Inc. (New Jersey) on NCQA Report Cards. HRA, 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. 2 Based on results from the 2021 Aetna Disease Management Member Satisfaction Analysis. When billing, you must use the most appropriate code as of the effective date of the submission. Ratings emphasize care outcomes (the results of care) and what patients say about their care. Agreement and Collaboration With Clients. NCQA's Health Plan Accreditation program builds on almost three decades of experience measuring the quality of health plans. 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). This button displays the currently selected search type. Credentialing Accreditation assesses an organizations performance in the following areas: Find the Standards and Guidelines document in the NCQA Store. Share this page with a friend or colleague by Email. 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 responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Below are some of the most frequently asked questions about NCQA Credentialing Accreditation. Visit the secure website, available through www.aetna.com, for more information. Links to various non-Aetna sites are provided for your convenience only. Methodology Your benefits plan determines coverage. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. Satisfy state requirements and employer needs. Regulation and accreditation are not identical. Methodology Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 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. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. 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). 0000014217 00000 n Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Ask a Question. Purchase and review the program resources, conduct a gap analysis and submit your online application. Has a process for monitoring, evaluating and improving the quality and safety of care provided to its members, Reports audited HEDIS results for designated HEDIS. Align your organization's processes with the standards. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". 0000004583 00000 n have relied on Wellsource for innovative, evidence-based, NCQA-certified health risk assessment solutions to Interested in other accreditation options? Work with HealthHUB, MinuteClinic and Network to bring licensed clinical social workers in to stores and offer new services, such as life coaching. hbspt.cta._relativeUrls=true;hbspt.cta.load(3949674, '00e7b261-db89-4360-9393-9d0dda543729', {"useNewLoader":"true","region":"na1"}); Tags: 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. 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. NCQA Certification products represent a subset of the standards and guidelines for our Accreditation products and are appropriate for organizations that provide specific services, but not comprehensive programs. 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. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Applicable FARS/DFARS apply. 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. We have developed strict policies and procedures to protect member information including race, ethnicity and language preference information from inappropriate use and disclosure. NCQA's Health Plan Ratings 2024 include commercial, Medicare and Medicaid health plans. Collect, maintain and present data on race and ethnicity that leads to the development of effective member education, health prevention and patient care management programs. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 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. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 0000007964 00000 n Health benefits and health insurance plans contain exclusions and limitations. For a healthcare organization to earn an NCQA Health Plan Accreditation, it is required to meet standards encompassing more than 100 measured elements. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Please log in to your secure account to get what you need.

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