While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. xref The certification process requires a substantial amount of time and resources including usability testing, documentation, and product review and enhancement. 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. Establish a baseline representative of the demographic composition of Aetnas membership; and. Do you want to continue? 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. 0000000816 00000 n %%EOF Collaborate with Network to access telehealth use analytics and its impact on accessibility and availability. 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. Assess Aetna's health care provider networks' ability to meet race, ethnicity, culture and language communication needs and preferences of our member population. Quickly to Meet Program needs, Certification and Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". You will be prompted to log in to your NCQA account. If you are not currently accredited and want to learn more, contact NCQA. And for good reason if it were easy, just anyone could do it. We launched MinuteClinic HealthHUB pilots across four states to demonstrate CVS Healths commitment to mental health and access to mental health services and resources. We have developed strict policies and procedures to protect member information including race, ethnicity and language preference information from inappropriate use and disclosure. 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). Legal notices We developed Second Curve, Here4You and other suicide prevention campaigns to move beyond awareness and drive change. As one of the nations leading health plans, Aetnas members represent the countrys increasing diversity in race, ethnicity and language. Agreement and Collaboration With Clients. At least 9 months before desired survey start date: Begin the online application process. 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. 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. 0000001025 00000 n How do I get NCQA certified? The most important step employers can take is to encourage their employees to voluntarily provide information on their race and ethnicity to both their doctor and their health plan. More than 1,000 health plans have earned NCQA Accreditation and achieving accreditation is a lengthy process, representing a lot of work. 3.0. Download our case study to learn how vendors earn NCQA certification, and the value this recognition has brought toWellsourceclients for over a decade running. Treating providers are solely responsible for dental advice and treatment of members. Terms of Use, Patient-Centered Specialty Practice (PCSP), Credentials Verification Organization (CVO), Managed Behavioral Healthcare Organization (MBHO), Health Information Technology Prevalidation Programs, Virtual Seminars, Webinars and On-demand Training, Advertising and Marketing Your NCQA Status, database of additional common questions for Medicare, Medicaid and commercial plans, Use the NCQA Health Plan Accreditation standards to perform a gap analysis and determine improvement areas. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Health benefits and health insurance plans contain exclusions and limitations. For a healthcare organization to earn an NCQA Health Plan Accreditation, it is required to meet standards encompassing more than 100 measured elements. Has a process for monitoring, evaluating and improving the quality and safety of care provided to its members, Reports audited HEDIS results for designated HEDIS. READ SOMETHING ELSE The issue of health care disparities is immensely complex, but there are targeted solutions that can help us bridge the gap. trailer Some organizations may already be working within NCQA guidelines. It is only a partial, general description of plan or program benefits and does not constitute a contract. Please log in to your secure account to get what you need. 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. Regulation and accreditation are not identical. 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. When health plans work with vendors that have already passed NCQAs thorough review, they receive oversight relief for all the standards that apply. Your benefits plan determines coverage. to Fuel Marketing initiatives, Scale 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. Ask a Question. This search will use the five-tier subtype. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. drive informed decisions with actionable data. Please be sure to add a 1 before your mobile number, ex: 19876543210. This Agreement will terminate upon notice if you violate its terms. This accreditation is the latest endorsement that Aetna has received from the NCQA for its products or programs. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Wellsource, Topics: 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. 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. and achieving accreditation is a lengthy process, representing a lot of work. NCQA Health Insurance Plan Ratings 2019-2020 - Detail Report (Private) Plan Name: Aetna Life Insurance Company (Ohio) Rating: 3.5. We worked with BrandWatch to get social media analysis of mental health findings for adolescents and LGBTQ/BIPOC youth. CPT is a registered trademark of the American Medical Association. Maintain Your License. So why do health plans do it? NCQA conducts the survey and determines your accreditation status within 30 days of the final review. 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. The member's benefit plan determines coverage. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. REPORT CARDS. All Rights Reserved. We collected data on a set of clinical measures called Healthcare Effectiveness Data and Information Set (HEDIS), as applicable. If you are considering health plan accreditation, you have likely heard of theNational Committee for Quality Assurance(NCQA). Save your favorite pages and receive notifications whenever theyre updated. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. 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. Credentialing services include: Verifying healthcare provider credentials through a primary source or a contracted agent of the primary source. Over 1,350 providers have enrolled with a 61% course completion rate. Satisfaction remained high, and members are likely to recommend the program. Pricing is based on multiple factors. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Credentialing Accreditation assesses an organizations performance in the following areas: Find the Standards and Guidelines document in the NCQA Store. 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. 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 . Treating providers are solely responsible for dental advice and treatment of members. 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. 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. We were the first health appraisal vendor to be certified by NCQA and have received certification continuously since 2008. Find opportunities to ensure equitable access to health care. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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. Provides services through an organized delivery system that includes ambulatory and inpatient health care sites. Save your favorite pages and receive notifications whenever theyre updated. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. Links to various non-Aetna sites are provided for your convenience only. You will be prompted to log in to your NCQA account. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. So why do health plans do it? Health Care Accreditation, Health Plan Accreditation Organization - NCQA - NCQA The National Committee for Quality Assurance (NCQA) exists to improve the quality of health care. #IP#@w"+;#j}2%0Z2 In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Your benefits plan determines coverage. 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. 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. Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review. I = Insufficient data; NC = No Credit; NA = Not Applicable. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. The standards focus on: Quality Management and Improvement Population Health Management Network Management The 2024 ratings will be released electronically . Reprinted with permission. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. Applicable FARS/DFARS apply. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Download, NCQA NCQA Accreditation for Population Health Program (PHP) November 28, 2022 - November 28, 2025 OptumHealth Care Solutions, LLC. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. All Rights Reserved. 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.