Update educational materials and articles on the provider website to ensure that information is accurate. New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission. READ SOMETHING ELSE Your benefits plan determines coverage. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Eligible organizations: Note: A practitioner network is the practitioner network of clients and organizations. 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. Through the accreditation process, organizationsare able toperform a gap analysis and identify areas for improving their evidence-based practices. Weve partnered with Psych Hub to offer a customized suicide prevention training and certification program to all contracted network behavioral health and EAP providers at no cost. 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 first step to earning accreditation is a discussion with an NCQA program expert. Ratings emphasize care outcomes (the results of care) and what patients say about their care. If DHCS required NCQA accreditation and followed the 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. 70 0 obj <>stream 0000018406 00000 n Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Use the report cards to find health plans, practices, clinicians or other partners that meet NCQA standards and can help you drive improvement, keep people healthy and reduce health care costs. We also give you and your doctors information and tools that can help you make decisions. 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. Disclaimer of Warranties and Liabilities. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Credentialing Accreditation is for organizations that provide full scope credentialing services. The standardized survey process for plans of all types is constantly fine-tuned to keep pace with the changing health care environment. Certain races and ethnicities encounter certain diseases and conditions at higher rates. I am a results-driven Health Services professional with over 15 years of experience in Collecting, Organizing, Interpreting, Disseminating various types of data, Project/Program Management . NCQA conducts the survey and determines your accreditation status within 30 days of the final review. I = Insufficient data; NC = No Credit; NA = Not Applicable. 0000001025 00000 n kBtUp+v;J~)k>x@4l1%RuMALe0>6L(h(yI nL`suT;,y=PO#f{{0!4H6ISwB1"`rX`\'J$tS OTHER NAMES FOR THIS HEALTH PLAN. 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). 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. Unlisted, unspecified and nonspecific codes should be avoided. Find opportunities to ensure equitable access to health care. Accreditation HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). The IOQ will help service more individuals and families affected by autism and expand access to quality autism care. 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. The number of sites is also factored in, so fees typically range from $40,000 to $100,000 for three-year accreditation. It is only a partial, general description of plan or program benefits and does not constitute a contract. NCQA's Health Plan Accreditation program builds on almost three decades of experience measuring the quality of health plans. More than 90 organizations have earned NCQA Credentialing Accreditation. Programs like the National Committee for Quality Assurance (NCQA) Health Plan Accreditation rely on CAHPS to measure Medicare star ratings. Share this page with a friend or colleague by Email. Applicable FARS/DFARS apply. 3.0. 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. Legal notices 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. Weve improved every year from 2017 through 2021 in our Healthcare Effectiveness Data and Information Set HEDIS measures and. 0000001756 00000 n NCQA Confers Health Equity Accreditation on Elevance Health Medicaid Plans Aetna Medicaid Plan Recognized by NCQA for Health Equity Efforts UnitedHealthcare Grants Address Social Determinants of . 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. When health plans work with vendors that have already passed NCQAs thorough review, they receive oversight relief for all the standards that apply. Regulation and accreditation are not identical. Links to various non-Aetna sites are provided for your convenience only. NCQA will send you the handbook and application. 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. 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. Treating providers are solely responsible for medical advice and treatment of members. A complete listing of health plans and their NCQA accreditation status can be found on the NCQA website located at Its the only evaluation program that bases results on actual measurement of clinical performance (HEDIS measures) and consumer experience (CAHPS measures). 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. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Recognition, Download 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. 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. health risk assessment, Some plans exclude coverage for services or supplies that Aetna considers medically necessary. (NCQA). drive informed decisions with actionable data. Any organization that provides managed health care services can apply for the NCQA Health Plan Accreditation if it meets the following criteria: The first step to earning accreditation is a discussion with an NCQA program expert. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). Your benefits plan determines coverage. 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. 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. NCQA health plan accreditation is awidely-recognized, evidence-based program that works to ensure quality improvement and measurementthroughaligning organizations witha comprehensive framework. NCQA conducts the survey and determines your accreditation status within 30 days of the final review. The roadmap for improvement can include paying close attention to: The evaluation of these programs is based on clinical performance as well as consumer experience. Go to the American Medical Association Web site. Please be sure to add a 1 before your mobile number, ex: 19876543210. The typical evaluation time frame is 12 months from application submission to decision, depending on an organizations readiness. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers. An organization that earns Accreditation meets standards covering more than 100 measured elements. The member's benefit plan determines coverage. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". In 2019, NCQA rated more than 1,000 health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. The 2024 ratings will be released electronically . Condition-targeted health assessments for service line growth. NCQA Health Plan Accreditation is a widely recognized, evidence-based program dedicated to quality improvement and measurement. 2 Based on results from the 2021 Aetna Disease Management Member Satisfaction Analysis. It is important to note that Aetna uses this information only to improve the quality of care for our members and not for rating, underwriting, determining insurability, marketing or premium determinations. trailer 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). Need help with Medicare enrollment? Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. This information is neither an offer of coverage nor medical advice. The NCQA process was Implemented effective 3/1 8/2020 by the Credentialing Department at Aetna Better Health of Louisiana. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 0000004213 00000 n To improve satisfaction, we: Improved the accuracy of our provider directory information, Improved online self-service options for members and providers, We surveyed members in the Aetna Case Management program. NCQA Accreditation helps health plans demonstrate their commitment to quality and accountability and provides extraordinary benefits in today's market. ,) V-Wz/"HESru66x k#1:1eM8Q g`$d(d|jJ\]7CY]h:tUf5u{;=== fJ*F=(W3OiLz}mLT EN"TPrr5[U1 UEpQ_(!`9%1pcrYfgNrLB,e~'usgg=E@gIU wFGfMK_* T@F2w\0t~Xx[J4pKqa}o* ]xqx03P^=NcjdU1al7%D2y'AL,,UB,b6 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. Provides services through an organized delivery system that includes ambulatory and inpatient health care sites. 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. The face of America's workforce is changing rapidly as our nation's population of ethnic and racial minorities continues to grow. What is NCQA its history and key objectives? 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. 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. 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, 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. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. 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). More than 1,000 health plans have earned NCQA Accreditation and achieving accreditation is a lengthy process, representing a lot of work. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. 0000004583 00000 n The Benefit ofWorking with Certified Vendors to Achieve Health Plan Accreditation, As described above, seeking accreditation is anarduous process. The information contained in this article concerns the MCG care guidelines in the specified edition and as of the date of publication and may not reflect revisions made to the guidelines or any other developments in the subject matter after the publication date .

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