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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Please log in to your secure account to get what you need. Kristine is based out of Ventura County, California, United States and works in the Hospitals and Health Care industry. The typical evaluation time frame is 12 months from application submission to decision, depending on an organizations readiness. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 45 26
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. This accreditation is the latest endorsement that Aetna has received from the NCQA for its products or programs. Members should discuss any matters related to their coverage or condition with their treating provider. You will be prompted to log in to your NCQA account. Align your organization's processes with the CR standards. Accreditations See our recognition from trade associations, regulatory agencies and other governing bodies. Explore health plan accreditation with Wellsource. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). The member's benefit plan determines coverage. CPT is a registered trademark of the American Medical Association. When health plans work with vendors that have already passed NCQAs thorough review, they receive oversight relief for all the standards that apply. Program Evaluation Treatment Outcome Questionnaires Models, Organizational Health Care Surveys Pilot Projects Data Collection Prospective Studies Reproducibility of Results Electronic Health Records Retrospective Studies Cross-Sectional Studies Research Design Follow-Up Studies Ambulatory Care Interviews as Topic Feasibility . NCQA Accreditation helps health plans demonstrate their commitment to quality and accountability and provides extraordinary benefits in today's market. All Rights Reserved. Interested in other accreditation options? Your benefits plan determines coverage. Members also told us the assistance they received helped them better manage their health, We surveyed members in the Aetna Disease Management program. More than 90 organizations have earned NCQA Credentialing Accreditation. 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. In case of a conflict between your plan documents and this information, the plan documents will govern. 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. Lets take a look at the benefits of going with a certified vendor in the example use case of using health risk assessments (HRAs). Hear about our goals, the progress were making and how were tracking our efforts. The standards align with many state requirements. Workgroup Charter Health Care Accreditation, Health Plan Accreditation Organization - NCQA - NCQA The National Committee for Quality Assurance (NCQA) exists to improve the quality of health care. NCQA Certification products represent a subset of the standards and guidelines for our Accreditation products and are appropriate for organizations that provide specific services, but not comprehensive programs. 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). ncqa, READ SOMETHING ELSE Unlisted, unspecified and nonspecific codes should be avoided. More than 1,000health plans have earnedNCQA Accreditation and achieving accreditation is a lengthy process, representing a lot of work. Regulation involves rules that must be followed, while accreditation is a seal of approval (from some independent accrediting body) certifying that an organization or individual has met specific standards. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Weve improved every year from 2017 through 2021 in our Healthcare Effectiveness Data and Information Set HEDIS measures and. 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. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Save your favorite pages and receive notifications whenever theyre updated. Satisfy state requirements and employer needs. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Links to various non-Aetna sites are provided for your convenience only. NCQA Accreditation as of June 30, 2022. 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. It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. At least 9 months before desired survey start date: Begin the online application process. 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. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. 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. If you are considering health plan accreditation, you have likely heard of theNational Committee for Quality Assurance(NCQA). 0000002094 00000 n
health risk assessment, Work with HealthHUB, MinuteClinic and Network to bring licensed clinical social workers in to stores and offer new services, such as life coaching. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. This Agreement will terminate upon notice if you violate its terms. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Patient-Centered Medical Home (PCMH) Health Plan Accreditation HEDIS Measures Health Innovation Summit Organizations that earn a seal from NCQA show that they are serious about quality health care. Wellsourceis a certified vendor with NCQA. 70 0 obj
<>stream
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. Through the accreditation process, organizationsare able toperform a gap analysis and identify areas for improving their evidence-based practices. NCQA Health Plan Accreditation is a widely recognized, evidence-based program dedicated to quality improvement and measurement. The information you will be accessing is provided by another organization or vendor. \t_=)@S. Efforts to reduce disparities in health care could ultimately improve care and reduce overall health care costs. The rigor of this process is one way that accredited organizationscan signal theircommitmentto best practices and quality measures. Applicable FARS/DFARS apply. 0000007741 00000 n
Member privacy is paramount. 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. Visit the secure website, available through www.aetna.com, for more information. 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. 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. NCQA Accreditation for Population Health Program (PHP) November 28, 2022 - November 28, 2025 OptumHealth Care Solutions, LLC. 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. The member's benefit plan determines coverage. Need help with Medicare enrollment? Out of 26 MCPs in the state, 12 plans currently have NCQA accreditation, and four are pending an accreditation visit. 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). Assess Aetna's health care provider networks' ability to meet race, ethnicity, culture and language communication needs and preferences of our member population. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. They provide a framework for implementing evidence-based best practices. 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). 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 Change Data, Security You are now being directed to the CVS Health site. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Providers can receive the most effective, stress-free service. We asked members and providers how satisfied they are with Aetna. The information contained in this article concerns the MCG care guidelines in the specified edition and as of the date of publication and may not reflect revisions made to the guidelines or any other developments in the subject matter after the publication date . Pay the Final Fee and Earn Your License. For over 40 years, health plans, wellness organizations, and companies committed to improving health outcomes 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 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.