how does ncqa accreditation help aetna

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. Establish a baseline representative of the demographic composition of Aetnas membership; and. 12 months in advance: Become familiar with NCQA's required standards and processes. 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. The member's benefit plan determines coverage. 0000018406 00000 n Aetna Health Inc. . I = Insufficient data; NC = No Credit; NA = Not Applicable . Star ratings were created to help beneficiaries assess their care needs against the quality of Medicare Advantage health plans care and service. 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. If you dont see what youre looking for below, you can search NCQAs database of additional common questions for Medicare, Medicaid and commercial plans. The first step to earning accreditation is a discussion with an NCQA program expert. 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. You will be prompted to log in to your NCQA account. This button displays the currently selected search type. Purchase and review the program resources, conduct a gap analysis and submit your online application. 0000000816 00000 n This search will use the five-tier subtype. The roadmap for improvement can include paying close attention to: The evaluation of these programs is based on clinical performance as well as consumer experience. CPT is a registered trademark of the American Medical Association. 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. It is only a partial, general description of plan or program benefits and does not constitute a contract. The IOQ will help service more individuals and families affected by autism and expand access to quality autism care. Additionally, racial and ethnic information is important to a persons health plan. 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. Links to various non-Aetna sites are provided for your convenience only. 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. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. 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. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 0000001935 00000 n Accreditation HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). health risk assessment, The face of America's workforce is changing rapidly as our nation's population of ethnic and racial minorities continues to grow. Explore health plan accreditation with Wellsource. Unlisted, unspecified and nonspecific codes should be avoided. Satisfy state requirements and employer needs. to Fuel Marketing initiatives, Scale We created social media campaigns forLGBTQ and BIPOC youth. Out of 26 MCPs in the state, 12 plans currently have NCQA accreditation, and four are pending an accreditation visit. All Rights Reserved. If you do not intend to leave our site, close this message. 0000007276 00000 n Download our case study to learn how vendors earn NCQA certification, and the value this recognition has brought toWellsourceclients for over a decade running. Find opportunities to ensure equitable access to health care. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. 2 Based on results from the 2021 Aetna Disease Management Member Satisfaction Analysis. Visit the secure website, available through www.aetna.com, for more information. In 2019, NCQA rated more than 1,000 health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. 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. Asthma drug management Did people, . HWmoH_1A^UIi+/i6W\I_qT5=3/d6@Z*'hUMfId9oqH$v E$SG8Bo>m+w(;#ua\CVAZkY@]Ef^O?:SN9"},P:X%O{g=S<5po}#=tEWii*mF(b -.dD*Y5dmegs/kJ/1j-cv=p#eu|iBW.6Y56z Checklist, The Top 3 Benefits of Health Risk Assessments, 3 Healthcare Marketing Trends Taking Center Stage in 2023. Create and deliver quality improvement, management or assessment programs and processes. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. 0000007519 00000 n Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. All services deemed "never effective" are excluded from coverage. Your benefits plan determines coverage. One way were improving health care quality is by measuring how well we and others are doing. For language services, please call the number on your member ID card and request an operator. Others have four tiers, three tiers or two tiers. 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. 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. The standardized survey process for plans of all types is constantly fine-tuned to keep pace with the changing health care environment. Over 1,000 health plan products have earned NCQA Health Plan Accreditation. Pay the Final Fee and Earn Your License. 0000018200 00000 n 0000001756 00000 n Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Wellsourceis a certified vendor with NCQA. View Kristine Toppe's email address (t*****@ncqa***.org) and phone number. It's how we show our commitment to improving your quality of care, access to care and member satisfaction. Wellsource, Topics: CPT is a registered trademark of the American Medical Association. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Our provider network increased 6% in 2021. More than 173 million people are enrolled in NCQA-Accredited health plans. 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. CPT is a registered trademark of the American Medical Association. Update educational materials and articles on the provider website to ensure that information is accurate. Patient-Centered Medical Home (PCMH) Health Plan Accreditation HEDIS Measures Health Innovation Summit When billing, you must use the most appropriate code as of the effective date of the submission. This information is neither an offer of coverage nor medical advice. Health Standards, Data Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Recognition, Download Efforts to reduce disparities in health care could ultimately improve care and reduce overall health care costs. At least 9 months in advance: Conduct an analysis comparing current processes to NCQA requirements and adjust as necessary. We piloted new programs to help members manage addiction, depression, anxiety and eating disorders. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Collaborate with Network to access telehealth use analytics and its impact on accessibility and availability. NCQA Accreditation as of June 30, 2019. 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. Reprinted with permission. 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). 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 Providing employees of all racial and ethnic backgrounds with access to quality health care benefits and resources can help them stay healthy. 0000002094 00000 n trailer xref 0000002520 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). The NCQA makes the results public. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Accreditations See our recognition from trade associations, regulatory agencies and other governing bodies. The typical evaluation time frame is 12 months from application submission to decision, depending on an organizations readiness. 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. All services deemed "never effective" are excluded from coverage. 45 26 Member privacy is paramount. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. The ABA Medical Necessity Guidedoes not constitute medical advice. And for good reason if it were easy, just anyone could do it. Hear about our goals, the progress were making and how were tracking our efforts. and Compliance, Evidence-Based Health Plan Accreditation Our industry-leading accreditation is a rigorous assessment of health plans' structure and process, clinical quality and patient satisfaction . 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 Treating providers are solely responsible for medical advice and treatment of members. 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 . In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 0000001192 00000 n 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. Links to various non-Aetna sites are provided for your convenience only. <<354B25B36AD9EC4CB456011F0DE50B5F>]>> Thankfully, NCQA has streamlined part of the process through its vendor certification program, in which vendors can be vetted for quality by NCQAsee the full directory of approved vendors and accredited organizations here. 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. Others have four tiers, three tiers or two tiers. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. 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. Weve improved every year from 2017 through 2021 in our Healthcare Effectiveness Data and Information Set HEDIS measures and. URL: www.aetna.com. Measure the performance and outcomes of our programs and processes. At the very least, patients must be given tools that help them to speak more confidently and effectively with their health care providers so that they can take greater control of their health and well-being. CPT is a registered trademark of the American Medical Association. kBtUp+v;J~)k>x@4l1%RuMALe0>6L(h(yI nL`suT;,y=PO#f{{0!4H6ISwB1"`rX`\'J$tS Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Please be sure to add a 1 before your mobile number, ex: 19876543210, follow-up care for children prescribed ADHD medication (ADD), screen for co-existing mental health and substance use disorders, Measure, monitor and improve clinical care and quality of service, Launch company-wide initiatives to improve the safety of our members and communities, Make sure we obey all the rules, whether they come from plan sponsors, federal and state regulators, or accrediting groups, Developing policies and procedures that meet clinical practice standards, Reviewing preventive and behavioral health services and how care is coordinated, Addressing racial and ethnic disparitiesin health care that could negatively impact quality health care, Monitoring the effectiveness of our programs, Studying the accessibility and availability of ournetwork providers, Monitoring the overuse and underuse of services for our Medicare members, Performing credentialing and recredentialing activities, Assessing member and provider satisfaction.