Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. Ready to learn more about the NCQA certification process? Reprinted with permission. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. And we improved performance on many measures. 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. Share this page with a friend or colleague by Email. Aetna has taken a leadership role in finding and implementing solutions to the problem of health care disparities and for 10 years has been a catalyst for change. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 3 months before the survey start date: an Accreditation Services Coordinator from NCQA will contact your organization. Enter the email address you signed up with and we'll email you a reset link. More than 90 organizations have earned NCQA Credentialing Accreditation. 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. and Compliance, Evidence-Based 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. The certification process requires a substantial amount of time and resources including usability testing, documentation, and product review and enhancement. I am a results-driven Health Services professional with over 15 years of experience in Collecting, Organizing, Interpreting, Disseminating various types of data, Project/Program Management . If you do not intend to leave our site, close this message. Why Is NCQA Accreditation Important? - Wellsource NCQA Credentialing Accreditation Received | 5ACVO Our Accreditations | Optum NCQA Credentialing Accreditation is designed to ensure that organizations pursuing accreditation can maintain a high-quality network for members and contracted clients. 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. The face of America's workforce is changing rapidly as our nation's population of ethnic and racial minorities continues to grow. 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. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 45 26 Need help with Medicare enrollment? The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Credentialing Accreditation is for organizations that provide full scope credentialing services. 3.0. For language services, please call the number on your member ID card and request an operator. When health plans work with vendors that have already passed NCQAs thorough review, they receive oversight relief for all the standards that apply. The typical evaluation time frame is 12 months from application submission to decision, depending on an organizations readiness. As a result, many MCPs already follow NCQA guidelines with regard to care coordination or population health management. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". The AMA is a third party beneficiary to this Agreement. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Your benefits plan determines coverage. Visit the secure website, available through www.aetna.com, for more information. 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. This search will use the five-tier subtype. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. Condition-targeted health assessments for service line growth. One way were improving health care quality is by measuring how well we and others are doing. I = Insufficient data; NC = No Credit; NA = Not Applicable. Providing employees of all racial and ethnic backgrounds with access to quality health care benefits and resources can help them stay healthy. Quality improvement and care. Medical search. Frequent questions ages 5 to 64, with persistent asthma have an appropriate ratio of asthma medications to help control their symptoms? This evidence-based program provided psychoeducational coaching from clinical specialists to adult mentors. The first step to earning accreditation is a discussion with an NCQA program expert. 0000007519 00000 n If you are considering health plan accreditation, you have likely heard of theNational Committee for Quality Assurance(NCQA). Checklist, The Top 3 Benefits of Health Risk Assessments, 3 Healthcare Marketing Trends Taking Center Stage in 2023. Explore health plan accreditation with Wellsource. The information you will be accessing is provided by another organization or vendor. Providers can receive the most effective, stress-free service. Provides services through an organized delivery system that includes ambulatory and inpatient health care sites. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. The 2024 ratings will be released electronically . health plans, Don Hall, DrPH, CHES, Founder NCQA Accreditation standards are intended to help organizations achieve the highest level of performance possible, and create an environment of continuous improvement. Please log in to your secure account to get what you need. Private Health Insurance Plan Ratings - NCQA NCQA will send you the handbook and application. It is only a partial, general description of plan or program benefits and does not constitute a contract. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. 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. This accreditation is the latest endorsement that Aetna has received from the NCQA for its products or programs. 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. 0000002094 00000 n NCQA Reviews the Application. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. and achieving accreditation is a lengthy process, representing a lot of work. We do not share your information with third parties. Request an application. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. PDF National Medicaid - Quality Management Accreditation COMMUNICATION - Aetna The review process is rigorous and may consist of both an onsite and offsite evaluation. We were the first health appraisal vendor to be certified by NCQA and have received certification continuously since 2008. Here's what we did in 2021: Enhancing health and mental well-being leads to a better quality of life. 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. 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. Pricing is based on multiple factors. 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). 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. drive informed decisions with actionable data. Notification to Authorities and Practitioner Appeal Rights. 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. Over 1,000 health plan products have earned NCQA Health Plan Accreditation. Links to various non-Aetna sites are provided for your convenience only. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Report Cards - 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. Applicable FARS/DFARS apply. Organizations that earn a seal from NCQA show that they are serious about quality health care. NCQA conducts the survey and determines your accreditation status within 30 days of the final review. NCQA Accreditation Earning NCQA's Accreditation of Case Management for LTSS demonstrates that an organization is dedicated to coordinating the delivery of care in a person-centered and integrated manner to help individuals function optimally in their preferred setting. Patient-Centered Medical Home (PCMH) Health Plan Accreditation HEDIS Measures Health Innovation Summit 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. 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. 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.
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