Ready to learn more about the NCQA certification process? New and revised codes are added to the CPBs as they are updated. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Treating providers are solely responsible for medical advice and treatment of members. HRA, 45 0 obj <> endobj CPT only copyright 2015 American Medical Association. NCQA health plan accreditation is awidely-recognized, evidence-based program that works to ensure quality improvement and measurementthroughaligning organizations witha comprehensive framework. Call a licensed agent at 1-855-335-1407 (TTY: 711) , 7 days a week, 8 AM to 8 PM. Submit an inquiry through My NCQA. Wellsourceis a certified vendor with NCQA. 0000004344 00000 n 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. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. Maintain Your License. Companies use NCQA-certified HRAs and self-management tools because they know they provide quality data and a quality experience for the individuals who take them. NCQA conducts the survey and determines your accreditation status within 30 days of the final review. Disclaimer of Warranties and Liabilities. %PDF-1.4 % More than 90 organizations have earned NCQA Credentialing Accreditation. Out of 26 MCPs in the state, 12 plans currently have NCQA accreditation, and four are pending an accreditation visit. The health plan worked with NCQA to help test the concepts and application of the accreditation. This accreditation is the latest endorsement that Aetna has received from the NCQA for its products or programs. The first step to earning accreditation is a discussion with an NCQA program expert. NCQA surveys require six months of data, so by the time you're six months away from your survey's start date, you should be fully compliant with NCQA standards. Treating providers are solely responsible for medical advice and treatment of members. 0000018693 00000 n Purchase and review the program resources, conduct a gap analysis and submit your online application. 45 26 No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. and Compliance, Evidence-Based In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Collect, maintain and present data on race and ethnicity that leads to the development of effective member education, health prevention and patient care management programs. We launched our Caring Contacts program to provide resources and support to Aetna members discharged from an inpatient setting after a suicide attempt. 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 . See all legal notices See Accreditation status and health plan rating for Aetna Health Inc. (New Jersey) on NCQA Report Cards. 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. As a result, many MCPs already follow NCQA guidelines with regard to care coordination or population health management. New and revised codes are added to the CPBs as they are updated. An organization that earns Accreditation meets standards covering more than 100 measured elements. Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review. ? fZ IgBL- !|\W$D)8 F-JnvNzhkQOC6YSB~ O kk*t0pe]5{NLahbFs[q}dPm42iMUV%)) NCQA health plan accreditation is awidely-recognized, evidence-based program that works to ensure quality improvement and measurementthroughaligning organizations witha comprehensive framework. 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. Programs like the National Committee for Quality Assurance (NCQA) Health Plan Accreditation rely on CAHPS to measure Medicare star ratings. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. NCQA Credentialing Accreditation assesses any organization that offers credentialing services to ensure the organization can maintain a superior network for its contracted clients. Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. The overall rating is the weighted average of a plan's HEDIS and CAHPS measure ratings, plus bonus points for plans with a current Accreditation status as of June 30, 2024. NCQA's Health Plan Ratings 2024 include commercial, Medicare and Medicaid health plans. startxref Login. Applicable FARS/DFARS apply. Health benefits and health insurance plans contain exclusions and limitations. When billing, you must use the most appropriate code as of the effective date of the submission. Ratings emphasize care outcomes (the results of care) and what patients say about their care. 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. Ratings emphasize care outcomes (the results of care) and what patients say about their care. 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. We asked members and providers how satisfied they are with Aetna. Methodology 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. Medi-Cal Managed Care Health Plan (MCP) Accreditation Status August 2019. If you do not intend to leave our site, close this message. NCQA is ready to help! Below are some of the most frequently asked questions about NCQA Credentialing Accreditation. This information is neither an offer of coverage nor medical advice. Additionally, racial and ethnic information is important to a persons health plan. Our clinical activities and programs are based on proven guidelines. Legal notices to Change Data, Security 0000001192 00000 n No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. The IOQ will help service more individuals and families affected by autism and expand access to quality autism care. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Were working hard to improve the service, quality and safety of health care. NCQA accreditation standards help health plans and other organizations align future initiatives with issues that are front and center for employers and states. endstream endobj 69 0 obj <>/Size 45/Type/XRef>>stream Contact us at My.NCQA to ask about licensing the ratings data for research or display. NCQA's Health Plan Accreditation program builds on almost three decades of experience measuring the quality of health plans. Credentialing Accreditation is for organizations that provide full scope credentialing services. Each main plan type has more than one subtype. Purchase and review the program resources, conduct a gap analysis and submit your online application. It is only a partial, general description of plan or program benefits and does not constitute a contract. Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organizations survey readinessthe tool calculates your potential survey score. Members should discuss any matters related to their coverage or condition with their treating provider. 70 0 obj <>stream LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Wellsource:NCQA Certified, Committed toQuality andExcellence, Ready to learn more about the NCQA certification process? We developed Second Curve, Here4You and other suicide prevention campaigns to move beyond awareness and drive change. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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. xbbbd`b``l $ u 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. trailer Its the only evaluation program that bases results on actual measurement of clinical performance (HEDIS measures) and consumer experience (CAHPS measures). Quickly to Meet Program needs, Certification and Use the report cards to find health plans, practices, clinicians or other partners that meet NCQA standards and can help you drive improvement, keep people healthy and reduce health care costs. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Hear about our goals, the progress were making and how were tracking our efforts. 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). Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. NCQA conducts the survey and determines your accreditation status within 30 days of the final review. 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. 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.