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. Status. Reprinted with permission. Open Choice PPO, Aetna Select, Elect Choice EPO, OA Elect Choice EPO, Open Access Aetna Select NCQA Accreditation as of June 30, 2022 I = Insufficient data; NC = No Credit; NA = Not Applicable Contact us at My.NCQA to ask about licensing the ratings data for research or display. kBtUp+v;J~)k>x@4l1%RuMALe0>6L(h(yI
nL`suT;,y=PO#f{{0!4H6ISwB1"`rX`\'J$tS CPT only Copyright 2022 American Medical Association. Treating providers are solely responsible for medical advice and treatment of members. Please log in to your secure account to get what you need. Links to various non-Aetna sites are provided for your convenience only. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 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. NCQA health plan accreditation is awidely-recognized, evidence-based program that works to ensure quality improvement and measurementthroughaligning organizations witha comprehensive framework. This accreditation is the latest endorsement that Aetna has received from the NCQA for its products or programs. 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. If you are not currently accredited and want to learn more, contact NCQA. The AMA is a third party beneficiary to this Agreement. 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. NCQA conducts the survey and determines your accreditation status within 30 days of the final review. 0000018200 00000 n
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. Together with Autism Comprehensive Educational Services (ACES), weve created the first Aetna Institute of Quality (IOQ) for autism. In 2019, NCQA rated more than 1,000 health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. 0000002555 00000 n
Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. 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. As one of the nations leading health plans, Aetnas members represent the countrys increasing diversity in race, ethnicity and language. Purchase and review the program resources, conduct a gap analysis and submit your online application. Save your favorite pages and receive notifications whenever theyre updated. NCQA Health Equity Accreditation: Impact and Benefits startxref
Treating providers are solely responsible for medical advice and treatment of members. Asthma drug management Did people, . Go to the American Medical Association Web site. Links to various non-Aetna sites are provided for your convenience only. NCQA accreditation standards help health plans and other organizations align future initiatives with issues that are front and center for employers and states. 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. Medical organizations . NCQA Accreditation - California Each year, we use the results to set new goals and improve selected measures. And for good reason if it were easy, just anyone could do it. Has a process for monitoring, evaluating and improving the quality and safety of care provided to its members, Reports audited HEDIS results for designated HEDIS. 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. 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. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. PDF We offer quality health plans - Aetna While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Contact us Get member help Aetna members have access to contact information and resources specific to their plans. 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. The member's benefit plan determines coverage. 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. No fee schedules, basic unit, relative values or related listings are included in CPT. Kristine is based out of Ventura County, California, United States and works in the Hospitals and Health Care industry. We also work closely with numerous national health care organizations that have identified racial and ethnic disparities in health care as an issue that needs attention and action. What makes for an engaging health and wellness program? Quality Compass is a registered trademark of NCQA. At least 9 months before desired survey start date: Begin the online application process. Accreditation and Regulation: Can They Help Improve Patient Safety? Our Accreditations | Optum to Fuel Marketing initiatives, Scale Kristine Toppe - Assistant Vice President of State Affairs at Ncqa - Wiza When health plans work with vendors that have already passed NCQAs thorough review, they receive oversight relief for all the standards that apply. See the NCQA Report Card for a directory of accredited organizations. Methodology Racial and ethnic equity FAQs | Aetna 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. NCQA Health Equity Accreditation Plus | NCQA Education In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. View Kristine Toppe's email address (t*****@ncqa***.org) and phone number. All Rights Reserved. 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. 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. 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. Ratings emphasize care outcomes (the results of care) and what patients say about their care. What is NCQA its history and key objectives? 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. 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. Establish a baseline representative of the demographic composition of Aetnas membership; and. The standardized survey process for plans of all types is constantly fine-tuned to keep pace with the changing health care environment. 0000001465 00000 n
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). 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). 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. More than 1,000 health plans have earned NCQA Accreditation and achieving accreditation is a lengthy process, representing a lot of work. Wellsource:NCQA Certified, Committed toQuality andExcellence, Ready to learn more about the NCQA certification process? READ SOMETHING ELSE 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. NCQA Credentialing Accreditation Received | 5ACVO The first step to earning accreditation is a discussion with an NCQA program expert. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Quality management and improvement efforts | Aetna 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. Out of 26 MCPs in the state, 12 plans currently have NCQA accreditation, and four are pending an accreditation visit. 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. xb``c``y 3Ps400(e A1$/G #G JReqw@36&c`yXEH10FC PC
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 health plan accreditation is a widely-recognized, evidence-based program that works to ensure quality improvement and measurement through aligning organizations with a comprehensive framework. ages 5 to 64, with persistent asthma have an appropriate ratio of asthma medications to help control their symptoms? When billing, you must use the most appropriate code as of the effective date of the submission. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. 0
In 2005 and 2006, the NCQA recognized Aetna for reducing cultural gaps in health care access, and in 2006, Aetna was also the only insurer to receive the prestigious "Recognizing Innovation in Multicultural Health Care Award" from . All services deemed "never effective" are excluded from coverage. So why do health plans do it? This search will use the five-tier subtype. For a healthcare organization to earn an NCQA Health Plan Accreditation, it is required to meet standards encompassing more than 100 measured elements. PDF DHCS Care Coordination Project: NCQA Accreditation - California Simply call UnitedHealthcare at 877-842-3210, say or enter your tax identification number (TIN), and then say, as prompted, Other Professional Services > Credentialing > Medical > Join the Network.. How long does it take to be credentialed with UnitedHealthcare? Its the only evaluation program that bases results on actual measurement of clinical performance (HEDIS measures) and consumer experience (CAHPS measures). We launched an evidence-based 12-week pilot program with OUI Therapeutics/Vita Health for adults 18+ delivered virtually by clinical specialists to help lower suicide risk. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". 0000001192 00000 n
Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. When billing, you must use the most appropriate code as of the effective date of the submission. NCQA Credentialing Accreditation is designed to ensure that organizations pursuing accreditation can maintain a high-quality network for members and contracted clients. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. and Compliance, Evidence-Based Assess Aetna's health care provider networks' ability to meet race, ethnicity, culture and language communication needs and preferences of our member population. Engage members through pre-clinical coaching to address mental health issues before they become a crisis. 0000001781 00000 n
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). See Accreditation status and health plan rating for Aetna Health Inc. (New Jersey) on NCQA Report Cards. 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. 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). You are now being directed to CVS Caremark site. It's how we show our commitment to improving your quality of care, access to care and member satisfaction. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. You will be prompted to log in to your NCQA account. Employers, in turn, will benefit from increased productivity, lower absenteeism and, possibly, lower health care cost increases. Download our case study to learn how vendors earn NCQA certification, and the value this recognition has brought toWellsourceclients for over a decade running. This information is neither an offer of coverage nor medical advice. Download, NCQA Or ask a question through My NCQA. learn more URAC Accreditation for Health Call Center May 1, 2021 - May 1, 2024 Optum Serve Learn more It is important to note that Aetna uses this information only to improve the quality of care for our members and not for rating, underwriting, determining insurability, marketing or premium determinations. Collaborate with Network to access telehealth use analytics and its impact on accessibility and availability. Private Health Insurance Plan Ratings - NCQA 0000007276 00000 n
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). Treating providers are solely responsible for dental advice and treatment of members. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Workgroup Charter 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.