The member's benefit plan determines coverage. %%EOF More than 1,000health plans have earnedNCQA Accreditation and achieving accreditation is a lengthy process, representing a lot of work. 0 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. 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. 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). If an organization allows its Accreditation status to lapse, its UM, CR or PN Accreditation status will remain in place but may not be renewed. Visit the secure website, available through www.aetna.com, for more information. Categories include: Find the Standards and Guidelines document in the NCQA Store. endstream endobj 69 0 obj <>/Size 45/Type/XRef>>stream The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). Workgroup Charter Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. Do you want to continue? Health benefits and health insurance plans contain exclusions and limitations. 0000004063 00000 n The first step to earning accreditation is a discussion with an NCQA program expert. Purchase and review the program resources, conduct a gap analysis and submit your online application. Ready to learn more about the NCQA certification process? health risk assessment, Reprinted with permission. Weve partnered with Psych Hub to offer a customized suicide prevention training and certification program to all contracted network behavioral health and EAP providers at no cost. Treating providers are solely responsible for dental advice and treatment of members. Aetna Better Health of New Jersey. hbspt.cta._relativeUrls=true;hbspt.cta.load(3949674, '00e7b261-db89-4360-9393-9d0dda543729', {"useNewLoader":"true","region":"na1"}); Tags: xbbbd`b``l $ u Money Pit: Is Accreditation Always Worth the Cost? So why do health plans do it? Quality Compass is a registered trademark of NCQA. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 3.0. Search for Medicare Plans - NCQA We updated our app and provider directory to help members easily find providers who offer telemedicine. We do not share your information with third parties. 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. 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. Regulation and accreditation are not identical. 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 information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 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 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. A complete listing of health plans and their NCQA accreditation status can be found on the NCQA website located at Applicable FARS/DFARS apply. Employers, in turn, will benefit from increased productivity, lower absenteeism and, possibly, lower health care cost increases. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. You will be prompted to log in to your NCQA account. Certain races and ethnicities encounter certain diseases and conditions at higher rates. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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 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. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Do you want to continue? It's how we show our commitment to improving your quality of care, access to care and member satisfaction. 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. Understanding the CAHPS Survey | Aetna Unlisted, unspecified and nonspecific codes should be avoided. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Unlisted, unspecified and nonspecific codes should be avoided. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". It is only a partial, general description of plan or program benefits and does not constitute a contract. No fee schedules, basic unit, relative values or related listings are included in CPT. NCQA conducts the survey and determines your accreditation status within 30 days of the final review. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). For over 40 years, health plans, wellness organizations, and companies committed to improving health outcomes We were the first health appraisal vendor to be certified by NCQA and have received certification continuously since 2008. It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers. 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. Each main plan type has more than one 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). NCQA Accreditation helps health plans demonstrate their commitment to quality and accountability and provides extraordinary benefits in today's market. How do I get NCQA certified? Engage members through pre-clinical coaching to address mental health issues before they become a crisis. When health plans work with vendors that have already passed NCQAs thorough review, they receive oversight relief for all the standards that apply. Links to various non-Aetna sites are provided for your convenience only. NCQA requirements are a roadmap for improvementorganizations use them to perform a gap analysis and align improvement activities with areas that are most important to states and employers, such as network adequacy and consumer protection. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Go to the American Medical Association Web site. 0000007741 00000 n Patient-Centered Medical Home (PCMH) Recognition Interested in other accreditation options? 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). As one of the nations leading health plans, Aetnas members represent the countrys increasing diversity in race, ethnicity and language. NCQA accreditation standards help health plans and other organizations align future initiatives with issues that are front and center for employers and states. Racial and ethnic equity FAQs | Aetna 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. Accreditation HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Provides services through an organized delivery system that includes ambulatory and inpatient health care sites. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. CVS Health Receives NCQA Utilization Management Accreditation NCQA Accreditation as of June 30, 2022. Or ask a question through My NCQA. NCQA Accreditation - Area Agency on Aging of Northwest Michigan 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. An organization that earns Accreditation meets standards covering more than 100 measured elements. Were working hard to improve the service, quality and safety of health care. Disclaimer of Warranties and Liabilities. 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. DocFind - Aetna 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. And for good reason if it were easy, just anyone could do it. More than 173 million people are enrolled in NCQA-Accredited health plans. READ SOMETHING ELSE 0000013951 00000 n Save your favorite pages and receive notifications whenever theyre updated. Health benefits and health insurance plans contain exclusions and limitations. 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). 0000000016 00000 n 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). 0000007964 00000 n 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 For example, we work with groups of doctors and other health professionals to make health care better. Submit an inquiry through My NCQA. The issue of health care disparities is immensely complex, but there are targeted solutions that can help us bridge the gap. 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. This button displays the currently selected search type. 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. Our quality improvement program helps improve the behavioral health care we provide to you. Pay the Final Fee and Earn Your License.