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. Submit the Application and Pay the Application Fee. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. *NCQA-Accredited health plans or MBHOs are eligible for Accreditation in UM, CR or PN if they also maintain health plan or MBHO Accreditation. In 2019, NCQA rated more than 1,000 health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Thankfully, NCQA has streamlined part of the process through its vendor certification program, in which vendors can be vetted for quality by NCQAsee the full directory of approved vendors and accredited organizations here. Purchase and review the program resources, conduct a gap analysis and submit your online application. 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. Treating providers are solely responsible for medical advice and treatment of members. Providing employees of all racial and ethnic backgrounds with access to quality health care benefits and resources can help them stay healthy. Interested in other accreditation options? Quality Compass is a registered trademark of NCQA. Others have four tiers, three tiers or two tiers. Ready to learn more about the NCQA certification process? 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. We worked with BrandWatch to get social media analysis of mental health findings for adolescents and LGBTQ/BIPOC youth. The typical evaluation time frame is 12 months from application submission to decision, depending on an organizations readiness. Quickly to Meet Program needs, Certification and Medical organizations . 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. 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. Emphasis must be placed on encouraging healthy lifestyles, timely screenings, accessible medication and regular care. NCQA accreditation or interim accreditation, while an additional six MCPs are in the process of achieving accreditation; that is 18 of 24 currently contracted MCPs. Methodology The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. The review process is rigorous and may consist of both an onsite and offsite evaluation. ncqa, We developed Second Curve, Here4You and other suicide prevention campaigns to move beyond awareness and drive change. CPT only copyright 2015 American Medical Association. Purchase and review the program resources, conduct a gap analysis and submit your online application. Purchase and review the program resources, conduct a gap analysis and submit your online application. If you are currently accredited and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA. 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. Unlisted, unspecified and nonspecific codes should be avoided. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Update educational materials and articles on the provider website to ensure that information is accurate. Disclaimer of Warranties and Liabilities. learn more URAC Accreditation for Health Call Center May 1, 2021 - May 1, 2024 Optum Serve Learn more This information is neither an offer of coverage nor medical advice. Organizations that earn a seal from NCQA show that they are serious about quality health care. Medi-Cal Managed Care Health Plan (MCP) Accreditation Status August 2019. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. For language services, please call the number on your member ID card and request an operator. NCQA accreditation standards help health plans and other organizations align future initiatives with issues that are front and center for employers and states. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Data leads to insight about member health needs, which strengthens our ability to develop targeted initiatives. You will be prompted to log in to your NCQA account. All services deemed "never effective" are excluded from coverage. Health benefits and health insurance plans contain exclusions and limitations. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. The first step to earning accreditation is a discussion with an NCQA program expert. 0000002520 00000 n This certification signals our commitment to providing a best-in-class solution based on industry best practices and evidence-based research that will support health and improve outcomes. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. The 2024 ratings will be released electronically . health plans. The NCQA bases its general accreditation fee on a formula of $39,750 plus 16 cents per member if the plan's membership is over 50,000. Measure the performance and outcomes of our programs and processes. Share this page with a friend or colleague by Email. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Unlisted, unspecified and nonspecific codes should be avoided. Agreement and Collaboration With Clients. 0 Members also told us the assistance they received helped them better manage their health, We surveyed members in the Aetna Disease Management program. We created social media campaigns forLGBTQ and BIPOC youth. This Agreement will terminate upon notice if you violate its terms. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Maintain Your License. Pay the Final Fee and Earn Your License. The member's benefit plan determines coverage. Through the accreditation process, organizationsare able toperform a gap analysis and identify areas for improving their evidence-based practices. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. If you are not currently accredited and want to learn more, contact NCQA. Links to various non-Aetna sites are provided for your convenience only. Pricing is based on multiple factors. 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. 0000002555 00000 n Provides services through an organized delivery system that includes ambulatory and inpatient health care sites. 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. Some subtypes have five tiers of coverage. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Create and deliver quality improvement, management or assessment programs and processes. 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, 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. Please log in to your secure account to get what you need. The typical evaluation time frame is 12 months from application submission to decision, depending on an organizations readiness. Copyright 2023 National Committee for Quality Assurance. 0000018406 00000 n In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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 .
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