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Certain races and ethnicities encounter certain diseases and conditions at higher rates. 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. Learn about our efforts and how far weve come. 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. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. learn more URAC Accreditation for Health Call Center May 1, 2021 - May 1, 2024 Optum Serve Learn more Interested in other accreditation options? 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). \t_=)@S. 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. And we improved performance on many measures. 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. Quality Compass is a registered trademark of NCQA. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. You will be prompted to log in to your NCQA account. The NCQA makes the results public. 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. Our clinical activities and programs are based on proven guidelines. Align your organizations processes with the standards. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. 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. Analytical, Diagnostic and Therapeutic Techniques and Equipment 41. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. drive informed decisions with actionable data. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Submit an inquiry through My NCQA. NCQA Reviews the Application. OTHER NAMES FOR THIS HEALTH PLAN. Such data can lead to the development of specific initiatives that improve the health of people of various backgrounds based on their risks for certain conditions. Wellsource, Topics: 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. CPT is a registered trademark of the American Medical Association. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. This Agreement will terminate upon notice if you violate its terms. 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. %PDF-1.4 % Purchase and review the program resources, conduct a gap analysis and submit your online application. NCQA health plan accreditation is awidely-recognized, evidence-based program that works to ensure quality improvement and measurementthroughaligning organizations witha comprehensive framework. 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. CPT is a registered trademark of the American Medical Association. 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. The first step to earning accreditation is a discussion with an NCQA program expert. Health benefits and health insurance plans contain exclusions and limitations. We also give you and your doctors information and tools that can help you make decisions. REPORT CARDS. Maintain Your License. Organizations that earn a seal from NCQA show that they are serious about quality health care. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Others have four tiers, three tiers or two tiers. Create and deliver quality improvement, management or assessment programs and processes. New and revised codes are added to the CPBs as they are updated. Explore health plan accreditation with Wellsource. #IP#@w"+;#j}2%0Z2 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. Download, NCQA Hear about our goals, the progress were making and how were tracking our efforts. Share this page with a friend or colleague by Email. 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 . Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. 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 . Review Handbook and Application. See Accreditation status and health plan rating for Aetna Health Inc. (New Jersey) on NCQA Report Cards. Over 1,000 health plan products have earned NCQA Health Plan Accreditation. The National Committee for Quality Assurance's (NCQA) Diabetes Recognition Program (DRP) recognizes clinicians who have met standards demonstrating delivery of high-quality care to patients with diabetes. All Rights Reserved. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The ABA Medical Necessity Guidedoes not constitute medical advice. We have developed strict policies and procedures to protect member information including race, ethnicity and language preference information from inappropriate use and disclosure. 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). All Rights Reserved. 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. It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers. Aetna Student Health is the brand name for products and services provided by Aetna Life Insurance Company and its applicable affiliated companies (Aetna). Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 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. ncqa, 0000000816 00000 n Develop preventive health, early detection and disease management programs and processes. 0000014217 00000 n Copyright 2015 by the American Society of Addiction Medicine. 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). The AMA is a third party beneficiary to this Agreement. Disclaimer of Warranties and Liabilities. The member's benefit plan determines coverage. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Collaborate with Network to access telehealth use analytics and its impact on accessibility and availability. 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. Links to various non-Aetna sites are provided for your convenience only. Employees should make sure their doctor knows their racial and ethnic background in order to provide the best medical care. 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. As described above, seeking accreditation is anarduous process. We were the first health appraisal vendor to be certified by NCQA and have received certification continuously since 2008. We do not share your information with third parties. 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. 0000018200 00000 n Credentialing Accreditation is for organizations that provide full scope credentialing services. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Quality Compass is a registered trademark of NCQA. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. We work for better health care, better choices and better health. Through the accreditation process, organizationsare able toperform a gap analysis and identify areas for improving their evidence-based practices. Recognition, Download Establish a baseline representative of the demographic composition of Aetnas membership; and. NCQA conducts the survey and determines your accreditation status within 30 days of the final review. startxref CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services.