More than 1,000 health plans have earned NCQA Accreditation and achieving accreditation is a lengthy process, representing a lot of work. NCQA Accreditation helps health plans demonstrate their commitment to quality and accountability and provides extraordinary benefits in today's market. Applicable FARS/DFARS apply. kBtUp+v;J~)k>x@4l1%RuMALe0>6L(h(yI nL`suT;,y=PO#f{{0!4H6ISwB1"`rX`\'J$tS No fee schedules, basic unit, relative values or related listings are included in CPT. As a result, many MCPs already follow NCQA guidelines with regard to care coordination or population health management. 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). We developed Second Curve, Here4You and other suicide prevention campaigns to move beyond awareness and drive change. For example, we work with groups of doctors and other health professionals to make health care better. In 2019, NCQA rated more than 1,000 health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. In case of a conflict between your plan documents and this information, the plan documents will govern. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Health plans and accreditation status: Aetna Better Health of California Scheduled Treating providers are solely responsible for dental advice and treatment of members. It's how we show our commitment to improving your quality of care, access to care and member satisfaction. Links to various non-Aetna sites are provided for your convenience only. Download, NCQA NCQA Health Insurance Plan Ratings 2019-2020 - Detail Report (Private) Plan Name: Aetna Life Insurance Company (Ohio) Rating: 3.5. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. We take our NCQA accreditation seriously. 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. Ratings emphasize care outcomes (the results of care) and what patients say about their care. underwritten by Aetna Life Insurance Company (Aetna). Operates under an insurance license (e.g., HMO, POS, PPO, EPO). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 0000001781 00000 n Over 1,350 providers have enrolled with a 61% course completion rate. REPORT CARDS. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Your benefits plan determines coverage. ? fZ IgBL- !|\W$D)8 F-JnvNzhkQOC6YSB~ O kk*t0pe]5{NLahbFs[q}dPm42iMUV%)) 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. Others have four tiers, three tiers or two tiers. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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. xb``c``y 3Ps400(e A1$/G #G JReqw@36&c`yXEH10FC PC Emphasis must be placed on encouraging healthy lifestyles, timely screenings, accessible medication and regular care. 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. Treating providers are solely responsible for dental advice and treatment of members. 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. 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. CPT is a registered trademark of the American Medical Association. Members also told us the information they learned from the program had a positive effect on their lives, and their health improved because of the program. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 0000001465 00000 n Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Wellsource:NCQA Certified, Committed toQuality andExcellence, Ready to learn more about the NCQA certification process? Credentialing and recredentialing processes. Kristine is based out of Ventura County, California, United States and works in the Hospitals and Health Care industry. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Some subtypes have five tiers of coverage. View Kristine Toppe's email address (t*****@ncqa***.org) and phone number. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Work with HealthHUB, MinuteClinic and Network to bring licensed clinical social workers in to stores and offer new services, such as life coaching. 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. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. health risk assessment, So why do health plans do it? trailer /Size 49 /Info 8 0 R /Root 10 0 R /Prev 21523 /ID[060e888545013965100abd54e3afe5c1>060e888545013965100abd54e3afe5c1>] >> startxref 0 %%EOF 10 0 obj /Type . 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. Ready to learn more about the NCQA certification process? 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 American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Satisfaction remained high, and members are likely to recommend the program. 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. Health Care Accreditation, Health Plan Accreditation Organization - NCQA - NCQA The National Committee for Quality Assurance (NCQA) exists to improve the quality of health care. Lets take a look at the benefits of going with a certified vendor in the example use case of using health risk assessments (HRAs). Request an application. Please be sure to add a 1 before your mobile number, ex: 19876543210. Reprinted with permission. Each year, we use the results to set new goals and improve selected measures. Health Plan Accreditation Our industry-leading accreditation is a rigorous assessment of health plans' structure and process, clinical quality and patient satisfaction . It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers. 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). 2 Based on results from the 2021 Aetna Disease Management Member Satisfaction Analysis. Applicable FARS/DFARS apply. Please log in to your secure account to get what you need. Aetna Student Health is the brand name for products and services provided by Aetna Life Insurance Company and its applicable affiliated companies (Aetna). The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. At least 9 months before desired survey start date: Begin the online application process. 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). 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. The standards align with many state requirements. If you do not intend to leave our site, close this message. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). The first step to earning accreditation is a discussion with an NCQA program expert. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Learn about our efforts and how far weve come. 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). NCQA health plan accreditation is awidely-recognized, evidence-based program that works to ensure quality improvement and measurementthroughaligning organizations witha comprehensive framework. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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 . We created social media campaigns forLGBTQ and BIPOC youth. 70 0 obj <>stream NCQA Accreditation standards are intended to help organizations achieve the highest level of performance possible, and create an environment of continuous improvement. OTHER NAMES FOR THIS HEALTH PLAN. Align your organization's processes with the standards. Maintain Your License. Were working hard to improve the service, quality and safety of health care. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Medical organizations . 12 months in advance: Become familiar with NCQA's required standards and processes. NCQA Utilization Management Accreditation is a quality assessment program that focuses on consumer protection and customer service improvement. 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 status as of June 30, 2024. Health benefits and health insurance plans contain exclusions and limitations. 0000004063 00000 n No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Health benefits and health insurance plans contain exclusions and limitations. If you are considering health plan accreditation, you have likely heard of theNational Committee for Quality Assurance(NCQA). For language services, please call the number on your member ID card and request an operator. As one of the nations leading health plans, Aetnas members represent the countrys increasing diversity in race, ethnicity and language. 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. Recognition, Download Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Download our case study to learn how vendors earn NCQA certification, and the value this recognition has brought toWellsourceclients for over a decade running. 0000001025 00000 n The member's benefit plan determines coverage. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Credentialing Accreditation is for organizations that provide full scope credentialing services. 0000000016 00000 n Legal notices Save your favorite pages and receive notifications whenever theyre updated. 0000004583 00000 n 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. We were the first health appraisal vendor to be certified by NCQA and have received certification continuously since 2008. When billing, you must use the most appropriate code as of the effective date of the submission. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Share this page with a friend or colleague by Email. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. 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. to Change Data, Security We expanded support to youth ages 12 to 25 through OUI Therapeutics/Vita Health. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The member's benefit plan determines coverage. NCQA's Health Plan Accreditation program builds on almost three decades of experience measuring the quality of health plans. 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. NCQA Credentialing Accreditation assesses any organization that offers credentialing services to ensure the organization can maintain a superior network for its contracted clients. Checklist, The Top 3 Benefits of Health Risk Assessments, 3 Healthcare Marketing Trends Taking Center Stage in 2023. Credentialing services include: Verifying healthcare provider credentials through a primary source or a contracted agent of the primary source. 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. Simply call UnitedHealthcare at 877-842-3210, say or enter your tax identification number (TIN), and then say, as prompted, Other Professional Services > Credentialing > Medical > Join the Network.. How long does it take to be credentialed with UnitedHealthcare? 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 following accreditation status can be found on the National Committee for Quality Assurance (NCQA) website. 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. 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. And for good reason if it were easy, just anyone could do it. New and revised codes are added to the CPBs as they are updated. All Rights Reserved. NCQA will send you the handbook and application. Methodology READ SOMETHING ELSE 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. The review process is rigorous and may consist of both an onsite and offsite evaluation. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. The accreditations come after Aetna Better Health of Michigan, Inc., participated in an eight-month NCQA sponsored pilot to develop its Health Equity Accreditation Plus evaluation program.

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