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NCQA Accreditation as of June 30, 2022. 12 months in advance: Become familiar with NCQA's required standards and processes. We created social media campaigns forLGBTQ and BIPOC youth. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Health Standards, Data Call a licensed agent at 1-855-335-1407 (TTY: 711) , 7 days a week, 8 AM to 8 PM. Improved our patient safety programto help members make informed health choices, Used social media to share patient safety information, Provided patient safety resources to physicians on the secure provider website. This search will use the five-tier subtype. 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. NCQA Utilization Management Accreditation is a quality assessment program that focuses on consumer protection and customer service improvement. 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. xref Health Care Accreditation, Health Plan Accreditation Organization - NCQA - NCQA The National Committee for Quality Assurance (NCQA) exists to improve the quality of health care. Visit the secure website, available through www.aetna.com, for more information. 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. Links to various non-Aetna sites are provided for your convenience only. One way were improving health care quality is by measuring how well we and others are doing. Aetna Health Inc. . The member's benefit plan determines coverage. Provides services through an organized delivery system that includes ambulatory and inpatient health care sites. The first step to earning accreditation is a discussion with an NCQA program expert. Quickly to Meet Program needs, Certification and You are now being directed to the CVS Health site. If DHCS required NCQA accreditation and followed the 0000000816 00000 n 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. 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. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Or ask a question through My NCQA. It's how we show our commitment to improving your quality of care, access to care and member satisfaction. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. 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. Accreditations See our recognition from trade associations, regulatory agencies and other governing bodies. 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. ,) 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 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. Save your favorite pages and receive notifications whenever theyre updated. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). and Compliance, Evidence-Based Develop preventive health, early detection and disease management programs and processes. CPT is a registered trademark of the American Medical Association. Wellsourceis a certified vendor with NCQA. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Health plan accreditation requires the use of HRAs and self-management toolsand though organizations seeking accreditation can opt to build their own HRA or partner with a third-party for the solution, many find themselves weighing the pros and cons of building their own solution and opting instead to partner with a trustworthy vendor. Copyright 2023 National Committee for Quality Assurance. Share this page with a friend or colleague by Email. Purchase and review the program resources, conduct a gap analysis and submit your online application. Certain races and ethnicities encounter certain diseases and conditions at higher rates. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). Status. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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. Each main plan type has more than one subtype. 0000007276 00000 n Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. All services deemed "never effective" are excluded from coverage. This Agreement will terminate upon notice if you violate its terms. The IOQ will help service more individuals and families affected by autism and expand access to quality autism care. I = Insufficient data; NC = No Credit; NA = Not Applicable . Were working hard to improve the service, quality and safety of health care. The NCQA process was Implemented effective 3/1 8/2020 by the Credentialing Department at Aetna Better Health of Louisiana. The member's benefit plan determines coverage. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. You will be prompted to log in to your NCQA account. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. Medical organizations . Submit the Application and Pay the Application Fee. We do not share your information with third parties. HRA, We were the first health appraisal vendor to be certified by NCQA and have received certification continuously since 2008. #IP#@w"+;#j}2%0Z2 Align your organizations processes with the CR standards. 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. Disclaimer of Warranties and Liabilities. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Maintain Your License. Thankfully, NCQA has streamlined part of the process through its vendor certification program, in which vendors can be vetted for quality by NCQA, see the full directory of approved vendors and accredited organizations here. Quality Compass is a registered trademark of NCQA. NCQA Accreditation for Population Health Program (PHP) November 28, 2022 - November 28, 2025 OptumHealth Care Solutions, LLC. 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. Out of 26 MCPs in the state, 12 plans currently have NCQA accreditation, and four are pending an accreditation visit. 2 Based on results from the 2021 Aetna Disease Management Member Satisfaction Analysis. We are committed to improving services for preventive health, early detection and disease management for health conditions commonly seen in specific racial or ethnic groups. Request an application. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. \t_=)@S. Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation. 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 information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. The Benefit ofWorking with Certified Vendors to Achieve Health Plan Accreditation, As described above, seeking accreditation is anarduous process. Regulation and accreditation are not identical. Over 1,350 providers have enrolled with a 61% course completion rate. 0000001781 00000 n Applicable FARS/DFARS apply. 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. health plans. At least 9 months before desired survey start date: Begin the online application process.