45 26 When expanded it provides a list of search options that will switch the search inputs to match the current selection. 0000001465 00000 n #IP#@w"+;#j}2%0Z2 Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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. 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. NCQA Health Insurance Plan Ratings Detail - National Committee for 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. The following accreditation status can be found on the National Committee for Quality Assurance (NCQA) website. trailer /Size 49 /Info 8 0 R /Root 10 0 R /Prev 21523 /ID[060e888545013965100abd54e3afe5c1>060e888545013965100abd54e3afe5c1>] >> startxref 0 %%EOF 10 0 obj /Type . health risk assessment, Missy Krasner on LinkedIn: Fort Health - a New Model to Tackle the 70 0 obj <>stream Aetna Student Health is the brand name for products and services provided by Aetna Life Insurance Company and its applicable affiliated companies (Aetna). 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. Accreditation HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. We do not share your information with third parties. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. We updated our app and provider directory to help members easily find providers who offer telemedicine. Credentialing Accreditation is for organizations that provide full scope credentialing services. 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. Our clinical activities and programs are based on proven guidelines. Analytical, Diagnostic and Therapeutic Techniques and Equipment 41. CPT only Copyright 2022 American Medical Association. Maintain Your License. Emphasis must be placed on encouraging healthy lifestyles, timely screenings, accessible medication and regular care. Share this page with a friend or colleague by Email. <<354B25B36AD9EC4CB456011F0DE50B5F>]>> What is NCQA behavioral health? [FAQs!] - wellbeingport.com Detailed Health Insurance Plan Ratings for Aetna Better Health Inc., a Pennsylvania Corporation from 2019 - 2020 . Also, language and cultural barriers must be eliminated. Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organizations survey readinessthe tool calculates your potential survey score. Accreditation Status of Health Plans Report - California Patient-Centered Medical Home (PCMH) Recognition Build vs. Buy: Which Health Risk Assessment Approach is Right for You. This Agreement will terminate upon notice if you violate its terms. Each year, we use the results to set new goals and improve selected measures. We created social media campaigns forLGBTQ and BIPOC youth. ,) 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 Health Care Accreditation, Health Plan Accreditation Organization - NCQA - NCQA The National Committee for Quality Assurance (NCQA) exists to improve the quality of health care. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. NCQA Credentialing Accreditation is designed to ensure that organizations pursuing accreditation can maintain a high-quality network for members and contracted clients. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. No fee schedules, basic unit, relative values or related listings are included in CPT. The first step to earning accreditation is a discussion with an NCQA program expert. 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. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. The issue of health care disparities is immensely complex, but there are targeted solutions that can help us bridge the gap. 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 . 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. 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. Applicable FARS/DFARS apply. NCQA Health Equity Accreditation: Impact and Benefits And for good reason if it were easy, just anyone could do it. 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. Unlisted, unspecified and nonspecific codes should be avoided. 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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. What is NCQA Certification? - Verisys NCQA conducts the survey and determines your accreditation status within 30 days of the final review. Racial and ethnic equity FAQs | Aetna For example, we work with groups of doctors and other health professionals to make health care better. Health plans and accreditation status: Aetna Better Health of California Scheduled The NCQA makes the results public. Providers can receive the most effective, stress-free service. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. %%EOF Submit the Application and Pay the Application Fee. 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. Others have four tiers, three tiers or two tiers. 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. kBtUp+v;J~)k>x@4l1%RuMALe0>6L(h(yI nL`suT;,y=PO#f{{0!4H6ISwB1"`rX`\'J$tS The information you will be accessing is provided by another organization or vendor. NCQA's Health Plan Accreditation program builds on almost three decades of experience measuring the quality of health plans. Copyright 2015 by the American Society of Addiction Medicine. 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. Links to various non-Aetna sites are provided for your convenience only. When health plans work with vendors that have already passed NCQAs thorough review, they receive oversight relief for all the standards that apply. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 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. Some organizations may already be working within NCQA guidelines. 0000001935 00000 n CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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). 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). 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. Operates under an insurance license (e.g., HMO, POS, PPO, EPO). CPT is a registered trademark of the American Medical Association. 0000004508 00000 n Weve improved every year from 2017 through 2021 in our Healthcare Effectiveness Data and Information Set HEDIS measures and. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 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. REPORT CARDS. Frankie Alstin-Brooks, PhD - Human Resources Partner - LinkedIn No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 0 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. 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. We work for better health care, better choices and better health. More than 1,000 health plans have earned NCQA Accreditation and achieving accreditation is a lengthy process, representing a lot of work. NCQA Credentialing Accreditation means that the caliber of the CVO's credentialing process is first-class. NCQA will send you the handbook and application. Member privacy is paramount. The standards align with many state requirements. Interested in other accreditation options? Others have four tiers, three tiers or two tiers. The standardized survey process for plans of all types is constantly fine-tuned to keep pace with the changing health care environment. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. FAQs - Health Plan Accreditation - NCQA