Issues a contract for insurance for a defined population or contracts with an employer to provide managed care services for a self-insured population. NCQA Accreditation as of June 30, 2019. Some subtypes have five tiers of coverage. Engage members through pre-clinical coaching to address mental health issues before they become a crisis. ncqa, In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. As a result, many MCPs already follow NCQA guidelines with regard to care coordination or population health management. Reprinted with permission. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Obtain full pricing information by submitting a request through My NCQA. This search will use the five-tier subtype. Unlisted, unspecified and nonspecific codes should be avoided. If you dont see what youre looking for below, you can search NCQAs database of additional common questions for Medicare, Medicaid and commercial plans. RESOURCES FOR HEALTH PLANS. 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. The member's benefit plan determines coverage. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. NCQA Health Insurance Plan Ratings 2019-2020 - Detail Report (Private) Plan Name: Aetna Life Insurance Company (Ohio) Rating: 3.5. The AMA is a third party beneficiary to this Agreement. Applicable FARS/DFARS apply. Pricing is based on multiple factors. 2 Based on results from the 2021 Aetna Disease Management Member Satisfaction Analysis. REPORT CARDS. New and revised codes are added to the CPBs as they are updated. The face of America's workforce is changing rapidly as our nation's population of ethnic and racial minorities continues to grow. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. HWmoH_1A^UIi+/i6W\I_qT5=3/d6@Z*'hUMfId9oqH$v E$SG8Bo>m+w(;#ua\CVAZkY@]Ef^O?:SN9"},P:X%O{g=S<5po}#=tEWii*mF(b -.dD*Y5dmegs/kJ/1j-cv=p#eu|iBW.6Y56z This search will use the five-tier subtype. 3 months before the survey start date: an Accreditation Services Coordinator from NCQA will contact your organization. Regulation involves rules that must be followed, while accreditation is a seal of approval (from some independent accrediting body) certifying that an organization or individual has met specific standards. You are now being directed to CVS Caremark site. Please be sure to add a 1 before your mobile number, ex: 19876543210. Ask a Question. 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 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). The standards align with many state requirements. 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 Program Evaluation Treatment Outcome Questionnaires Models, Organizational Health Care Surveys Pilot Projects Data Collection Prospective Studies Reproducibility of Results Electronic Health Records Retrospective Studies Cross-Sectional Studies Research Design Follow-Up Studies Ambulatory Care Interviews as Topic Feasibility . 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. We shared the results with the National Committee for Quality Assurance (NCQA) Quality Compass. Create and deliver quality improvement, management or assessment programs and processes. We have developed strict policies and procedures to protect member information including race, ethnicity and language preference information from inappropriate use and disclosure. More than 90 organizations have earned NCQA Credentialing Accreditation. 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. 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). Providing employees of all racial and ethnic backgrounds with access to quality health care benefits and resources can help them stay healthy. For over 40 years, health plans, wellness organizations, and companies committed to improving health outcomes When health plans work with vendors that have already passed NCQAs thorough review, they receive oversight relief for all the standards that apply. 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. 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). 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). CPT only copyright 2015 American Medical Association. 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. CPT only copyright 2015 American Medical Association. Find opportunities to ensure equitable access to health care. See the NCQA Report Card for a directory of accredited organizations. 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 At least 9 months in advance: Conduct an analysis comparing current processes to NCQA requirements and adjust as necessary. Organizations that earn a seal from NCQA show that they are serious about quality health care. Aetna Health Inc. . Quality Compass is a registered trademark of 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. Agreement and Collaboration With Clients. As described above, seeking accreditation is anarduous process. If you dont see what youre looking for below, you can search NCQAs database of additional common questionsor ask a question through My NCQA. to Change Data, Security 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. You will be prompted to log in to your NCQA account. We also give you and your doctors information and tools that can help you make decisions. Applicable FARS/DFARS apply. Health benefits and health insurance plans contain exclusions and limitations. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Understand your population's health risks and improve health outcomes. Here's what we did in 2021: Enhancing health and mental well-being leads to a better quality of life. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. 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. Purchase and review the program resources, conduct a gap analysis and submit your online application. Contact us Get member help Aetna members have access to contact information and resources specific to their plans. They provide a framework for implementing evidence-based best practices. We launched MinuteClinic HealthHUB pilots across four states to demonstrate CVS Healths commitment to mental health and access to mental health services and resources. Satisfy state requirements and employer needs. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Emphasis must be placed on encouraging healthy lifestyles, timely screenings, accessible medication and regular care. 0000004508 00000 n xbbbd`b``l $ u Legal notices 0000018200 00000 n 0000017970 00000 n Companies use NCQA-certified HRAs and self-management tools because they know they provide quality data and a quality experience for the individuals who take them. This Agreement will terminate upon notice if you violate its terms. Copyright 2015 by the American Society of Addiction Medicine. 0000007276 00000 n Go to the American Medical Association Web site. Employees should make sure their doctor knows their racial and ethnic background in order to provide the best medical care. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organizations survey readinessthe tool calculates your potential survey score. Call a licensed agent at 1-855-335-1407 (TTY: 711) , 7 days a week, 8 AM to 8 PM. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Ratings emphasize care outcomes (the results of care) and what patients say about their care. Aetna is committed to Accreditation by the National Committee for Quality Assurance (NCQA) as a means of demonstrating a commitment to continuous quality improvement and meeting customer expectations. Star ratings were created to help beneficiaries assess their care needs against the quality of Medicare Advantage health plans care and service. We use information our members voluntarily provide to create our Racial and Ethnic Equity Dashboard (REED) report. Align your organization's processes with the CR standards. This information is neither an offer of coverage nor medical advice. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If you have questions about a Med Premier major medical plan, call The Boon Group at the toll-free number on your member ID card. 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. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern.