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. Links to various non-Aetna sites are provided for your convenience only. If you dont see what youre looking for below, you can search NCQAs database of additional common questionsor ask a question through My NCQA. 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. 0000018200 00000 n We take our NCQA accreditation seriously. 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). 0000001781 00000 n 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. We have developed strict policies and procedures to protect member information including race, ethnicity and language preference information from inappropriate use and disclosure. 0000018406 00000 n Visit the secure website, available through www.aetna.com, for more information. We developed Second Curve, Here4You and other suicide prevention campaigns to move beyond awareness and drive change. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Satisfy state requirements and employer needs. 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 excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. The standardized survey process for plans of all types is constantly fine-tuned to keep pace with the changing health care environment. Ratings emphasize care outcomes (the results of care) and what patients say about their care. 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. Quality Management & Improvement Efforts | Aetna Medicare xbbbd`b``l $ u Please log in to your secure account to get what you need. This Agreement will terminate upon notice if you violate its terms. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. All Rights Reserved. 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). HRA, ages 5 to 64, with persistent asthma have an appropriate ratio of asthma medications to help control their symptoms? 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.
Harder Than Metaphor,
Vermont Temporary Registration Out Of State,
Shooting In Tappahannock Virginia Last Night,
Hannah Haller And Pablo,
Articles H