Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. NCQA certification is a testament to a companys commitment to participant experience and scientific validity. The member's benefit plan determines coverage. We take our NCQA accreditation seriously. 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. 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. 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. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Kristine works at Ncqa as Assistant Vice President of State Affairs. RESOURCES FOR HEALTH PLANS. Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organizations survey readinessthe tool calculates your potential survey score. Measure the performance and outcomes of our programs and processes. These standards cover areas like care planning, measurement and quality improvement, and care monitoring, to name a few. 0000018406 00000 n Satisfy state requirements and employer needs. 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. 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. 0000001781 00000 n Health Care Accreditation, Health Plan Accreditation Organization - NCQA - NCQA The National Committee for Quality Assurance (NCQA) exists to improve the quality of health care. 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. You are now being directed to the CVS Health site. Applicable FARS/DFARS apply. 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. ncqa, 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. Treating providers are solely responsible for dental advice and treatment of members. This information is neither an offer of coverage nor medical advice. 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. 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. Find opportunities to ensure equitable access to health care. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. The AMA is a third party beneficiary to this Agreement. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. New and revised codes are added to the CPBs as they are updated. Were working hard to improve the service, quality and safety of health care. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. CPT is a registered trademark of the American Medical Association. 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). Some subtypes have five tiers of coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Ask a Question. to 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. Your benefits plan determines coverage. As a result, many MCPs already follow NCQA guidelines with regard to care coordination or population health management. to Fuel Marketing initiatives, Scale Health Standards, Data This button displays the currently selected search type. Some organizations may already be working within NCQA guidelines. Links to various non-Aetna sites are provided for your convenience only. Each year, we use the results to set new goals and improve selected measures. So why do health plans do it? While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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 . Collaborate with Network to access telehealth use analytics and its impact on accessibility and availability. See all legal notices Align your organizations processes with the standards. The Benefit ofWorking with Certified Vendors to Achieve Health Plan Accreditation, As described above, seeking accreditation is anarduous process. 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). 0000007741 00000 n Members also told us the assistance they received helped them better manage their health, We surveyed members in the Aetna Disease Management program. Or ask a question through My NCQA. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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. I = Insufficient data; NC = No Credit; NA = Not Applicable. 0000004508 00000 n NCQA Credentialing Accreditation means that the caliber of the CVO's credentialing process is first-class. Credentialing services include: Verifying healthcare provider credentials through a primary source or a contracted agent of the primary source. 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. Since Clinical Policy Bulletins (CPBs) 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. Create and deliver quality improvement, management or assessment programs and processes. 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. Learn about our efforts and how far weve come. Unlisted, unspecified and nonspecific codes should be avoided. When billing, you must use the most appropriate code as of the effective date of the submission. Categories include: Find the Standards and Guidelines document in the NCQA Store. For a healthcare organization to earn an NCQA Health Plan Accreditation, it is required to meet standards encompassing more than 100 measured elements. We also give you and your doctors information and tools that can help you make decisions. More people are using telemedicine. Employees should make sure their doctor knows their racial and ethnic background in order to provide the best medical care. Contact us Get member help Aetna members have access to contact information and resources specific to their plans. NCQA Accreditation standards are intended to help organizations achieve the highest level of performance possible, and create an environment of continuous improvement. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Satisfaction remained high, and members are likely to recommend the program. 0000001756 00000 n Do you want to continue? Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation. The Ultimate Guide to Health Risk Assessments, A Large Employer Realizes Over $85,000 in Direct ROI from the Wellsource HRA, Checklist: Choosing the Right Health Risk Assessment, If you are considering health plan accreditation, you have likely heard of the. Below are some of the most frequently asked questions about NCQA Health Plan Accreditation. endstream endobj 46 0 obj <>/Metadata 5 0 R/PieceInfo<>>>/Pages 4 0 R/PageLayout/OneColumn/StructTreeRoot 7 0 R/Type/Catalog/Lang( E N - U S)/LastModified(D:20091014145733)/PageLabels 2 0 R>> endobj 47 0 obj <>/Font<>/ProcSet[/PDF/Text]/ExtGState<>>>/Type/Page>> endobj 48 0 obj [49 0 R] endobj 49 0 obj <>/A 57 0 R/F 4/H/I/StructParent 1/Border[0 0 0]/Type/Annot>> endobj 50 0 obj <> endobj 51 0 obj <> endobj 52 0 obj [/ICCBased 58 0 R] endobj 53 0 obj <>stream 0000002094 00000 n Quality Compass is a registered trademark of NCQA. Ratings emphasize care outcomes (the results of care) and what patients say about their care. Legal notices 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. This search will use the five-tier subtype. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Copyright 2015 by the American Society of Addiction Medicine. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Hear about our goals, the progress were making and how were tracking our efforts. Unlisted, unspecified and nonspecific codes should be avoided. xbbbd`b``l $ u NCQA Health Insurance Plan Ratings 2019-2020 - Detail Report (Private) Plan Name: Aetna Life Insurance Company (Ohio) Rating: 3.5. to Change Data, Security Obtain full pricing information by submitting a request through My NCQA. NCQA's Health Equity Accreditation Plus helps health care organizations that have implemented core Health Equity Accreditation activities establish processes and cross-sector partnerships that identify and address social risk factors in their communities and the social needs of the people they serve. 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. 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. 45 0 obj <> endobj trailer /Size 49 /Info 8 0 R /Root 10 0 R /Prev 21523 /ID[060e888545013965100abd54e3afe5c1>060e888545013965100abd54e3afe5c1>] >> startxref 0 %%EOF 10 0 obj /Type . Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Standards recognize that organizations that apply for accreditation have open access networks, and can improve service quality and utilize customized structures to meet purchaser needs. The certification process requires a substantial amount of time and resources including usability testing, documentation, and product review and enhancement. Workgroup Charter Explore health plan accreditation with Wellsource. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 3 months before the survey start date: an Accreditation Services Coordinator from NCQA will contact your organization. 3.0. 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. 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. NCQA Accreditation for Population Health Program (PHP) November 28, 2022 - November 28, 2025 OptumHealth Care Solutions, LLC. 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. 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. Quality Compass is a registered trademark of NCQA. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Treating providers are solely responsible for medical advice and treatment of members. Health benefits and health insurance plans contain exclusions and limitations. Align your organizations processes with the CR standards. To improve satisfaction, we: Improved the accuracy of our provider directory information, Improved online self-service options for members and providers, We surveyed members in the Aetna Case Management program. All services deemed "never effective" are excluded from coverage.