kBtUp+v;J~)k>x@4l1%RuMALe0>6L(h(yI nL`suT;,y=PO#f{{0!4H6ISwB1"`rX`\'J$tS NCQA accreditation standards help health plans and other organizations align future initiatives with issues that are front and center for employers and states. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. health risk assessment, Unlisted, unspecified and nonspecific codes should be avoided. Call a licensed agent at 1-855-335-1407 (TTY: 711) , 7 days a week, 8 AM to 8 PM. Reprinted with permission. Visit the secure website, available through www.aetna.com, for more information. For example, we work with groups of doctors and other health professionals to make health care better. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. CPT only Copyright 2022 American Medical Association. Download, NCQA NCQA requirements are a roadmap for improvementorganizations use them to perform a gap analysis and align improvement activities with areas that are most important to states and employers, such as network adequacy and consumer protection. Do you want to continue? 45 0 obj <> endobj More than 173 million people are enrolled in NCQA-Accredited health plans. At least 9 months before desired survey start date: Begin the online application process. to Change Data, Security We do not share your information with third parties. Find opportunities to ensure equitable access to health care. Save your favorite pages and receive notifications whenever theyre updated. ages 5 to 64, with persistent asthma have an appropriate ratio of asthma medications to help control their symptoms? Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Employers, in turn, will benefit from increased productivity, lower absenteeism and, possibly, lower health care cost increases. Over 1,000 health plan products have earned NCQA Health Plan Accreditation. Others have four tiers, three tiers or two tiers. 0000004508 00000 n If DHCS required NCQA accreditation and followed the For language services, please call the number on your member ID card and request an operator. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. Members should discuss any matters related to their coverage or condition with their treating provider. 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). Were working hard to improve the service, quality and safety of health care. Together with Autism Comprehensive Educational Services (ACES), weve created the first Aetna Institute of Quality (IOQ) for autism. Standards recognize that organizations that apply for accreditation have open access networks, and can improve service quality and utilize customized structures to meet purchaser needs. 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). Methodology The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. 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. Go to the American Medical Association Web site. This workgroup will provide input on topics related to the standards and processes of requiring all MCPs to obtain NCQA accreditation, including consideration of the proposed accreditation requirements. Copyright 2023 National Committee for Quality Assurance. Links to various non-Aetna sites are provided for your convenience only. Some organizations may already be working within NCQA guidelines. Currently, 14 MCPs are accredited and 15 MCPs are not accredited. 0000004344 00000 n Status. Align your organization's processes with the standards. 0000004213 00000 n Aetna Student Health is the brand name for products and services provided by Aetna Life Insurance Company and its applicable affiliated companies (Aetna). Purchase and review the program resources, conduct a gap analysis and submit your online application. 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. NCQA conducts the survey and determines your accreditation status within 30 days of the final review. Health benefits and health insurance plans contain exclusions and limitations. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Enter the email address you signed up with and we'll email you a reset link. CPT is a registered trademark of the American Medical Association. Ratings emphasize care outcomes (the results of care) and what patients say about their care. 0000001025 00000 n Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Treating providers are solely responsible for dental advice and treatment of members. Links to various non-Aetna sites are provided for your convenience only. We also work closely with numerous national health care organizations that have identified racial and ethnic disparities in health care as an issue that needs attention and action. Others have four tiers, three tiers or two tiers. In addition to creating our own initiatives to fight disparities among our members, we encourage researchers at the nations top academic institutions and engage community-based organizations to address variations in health status and health care delivery among racial and ethnic populations. You are now being directed to CVS Caremark site. Copyright 2015 by the American Society of Addiction Medicine. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 45 26 Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. 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. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. See Accreditation status and health plan rating for Aetna Health Inc. (New Jersey) on NCQA Report Cards. CPT is a registered trademark of the American Medical Association. The IOQ will help service more individuals and families affected by autism and expand access to quality autism care. 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. 0000004063 00000 n 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. 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. Our provider network increased 6% in 2021. Maintain Your License. If you are not currently accredited and want to learn more, contact 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. 0000001465 00000 n Condition-targeted health assessments for service line growth. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. NCQA's Health Plan Ratings 2022. 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. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Kristine is based out of Ventura County, California, United States and works in the Hospitals and Health Care industry. 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. NCQA Accreditation for Population Health Program (PHP) November 28, 2022 - November 28, 2025 OptumHealth Care Solutions, LLC. Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation. Members should discuss any matters related to their coverage or condition with their treating provider. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 0000007276 00000 n If you are considering health plan accreditation, you have likely heard of theNational Committee for Quality Assurance(NCQA). 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. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Develop preventive health, early detection and disease management programs and processes. learn more URAC Accreditation for Health Call Center May 1, 2021 - May 1, 2024 Optum Serve Learn more Quality Compass is a registered trademark of NCQA. %PDF-1.4 % Treating providers are solely responsible for dental advice and treatment of members. And for good reason if it were easy, just anyone could do it. NCQA Accreditation Earning NCQA's Accreditation of Case Management for LTSS demonstrates that an organization is dedicated to coordinating the delivery of care in a person-centered and integrated manner to help individuals function optimally in their preferred setting. 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. The information you will be accessing is provided by another organization or vendor. NCQA's Health Equity Accreditation Plus helps health care organizations that have implemented core Health Equity Accreditation activities establish processes and cross-sector partnerships that identify and address social risk factors in their communities and the social needs of the people they serve.