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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. All services deemed "never effective" are excluded from coverage. 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. The information you will be accessing is provided by another organization or vendor. Over 1,350 providers have enrolled with a 61% course completion rate. Health Care Accreditation, Health Plan Accreditation Organization - NCQA - NCQA The National Committee for Quality Assurance (NCQA) exists to improve the quality of health care. 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, database of additional common questions for Medicare, Medicaid and commercial plans, Use the NCQA Health Plan Accreditation standards to perform a gap analysis and determine improvement areas. 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. health plans, Don Hall, DrPH, CHES, Founder Need help with Medicare enrollment? If you are not currently accredited and want to learn more, contact NCQA. Applicable FARS/DFARS apply. Obtain full pricing information by submitting a request through My NCQA. We do not share your information with third parties. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. The member's benefit plan determines coverage. Please be sure to add a 1 before your mobile number, ex: 19876543210, follow-up care for children prescribed ADHD medication (ADD), screen for co-existing mental health and substance use disorders, Measure, monitor and improve clinical care and quality of service, Launch company-wide initiatives to improve the safety of our members and communities, Make sure we obey all the rules, whether they come from plan sponsors, federal and state regulators, or accrediting groups, Developing policies and procedures that meet clinical practice standards, Reviewing preventive and behavioral health services and how care is coordinated, Addressing racial and ethnic disparitiesin health care that could negatively impact quality health care, Monitoring the effectiveness of our programs, Studying the accessibility and availability of ournetwork providers, Monitoring the overuse and underuse of services for our Medicare members, Performing credentialing and recredentialing activities, Assessing member and provider satisfaction. Success of our initiatives will be achieved if we can: In the end, true success will come when our members achieve improved health outcomes as a result of our targeted initiatives and programs. 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. 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 will be prompted to log in to your NCQA account. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Its the only evaluation program that bases results on actual measurement of clinical performance (HEDIS measures) and consumer experience (CAHPS measures). If you are considering health plan accreditation, you have likely heard of theNational Committee for Quality Assurance(NCQA). 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. Regulation and accreditation are not identical. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. to 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. 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 standardized survey process for plans of all types is constantly fine-tuned to keep pace with the changing health care environment. What is NCQA its history and key objectives? However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. They provide a framework for implementing evidence-based best practices. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Providers can receive the most effective, stress-free service. 0000002094 00000 n At the very least, patients must be given tools that help them to speak more confidently and effectively with their health care providers so that they can take greater control of their health and well-being. NCQA Credentialing Accreditation assesses any organization that offers credentialing services to ensure the organization can maintain a superior network for its contracted clients. 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. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. And for good reason if it were easy, just anyone could do it. The typical evaluation time frame is 12 months from application submission to decision, depending on an organizations readiness. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. When health plans work with vendors that have already passed NCQAs thorough review, they receive oversight relief for all the standards that apply. 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. Wellsource, Topics: 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. Through the accreditation process, organizationsare able toperform a gap analysis and identify areas for improving their evidence-based practices. The ABA Medical Necessity Guidedoes not constitute medical advice. Purchase and review the program resources, conduct a gap analysis and submit your online application. 70 0 obj <>stream Additionally, racial and ethnic information is important to a persons health plan. 0000002555 00000 n We collected data on a set of clinical measures called Healthcare Effectiveness Data and Information Set (HEDIS), as applicable. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Please log in to your secure account to get what you need. See all legal notices Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Methodology NCQA accreditation or interim accreditation, while an additional six MCPs are in the process of achieving accreditation; that is 18 of 24 currently contracted MCPs. \t_=)@S. Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review. 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. 0000004583 00000 n Submit an inquiry through My NCQA. 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. 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. Others have four tiers, three tiers or two tiers. kBtUp+v;J~)k>x@4l1%RuMALe0>6L(h(yI nL`suT;,y=PO#f{{0!4H6ISwB1"`rX`\'J$tS Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. We piloted new programs to help members manage addiction, depression, anxiety and eating disorders. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. The issue of health care disparities is immensely complex, but there are targeted solutions that can help us bridge the gap. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. This information is neither an offer of coverage nor medical advice. When expanded it provides a list of search options that will switch the search inputs to match the current selection. Methodology Call a licensed agent at 1-855-335-1407 (TTY: 711) , 7 days a week, 8 AM to 8 PM. Your benefits plan determines coverage. NCQA Utilization Management Accreditation is a quality assessment program that focuses on consumer protection and customer service improvement. ? fZ IgBL- !|\W$D)8 F-JnvNzhkQOC6YSB~ O kk*t0pe]5{NLahbFs[q}dPm42iMUV%)) Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. have relied on Wellsource for innovative, evidence-based, NCQA-certified health risk assessment solutions to NCQA is ready to help! NCQA certification is a testament to a companys commitment to participant experience and scientific validity. Each main plan type has more than one subtype. Satisfaction remained high, and members are likely to recommend the program. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. trailer Visit the secure website, available through www.aetna.com, for more information.
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