Do you want to continue? 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. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. PDF National Medicaid - Quality Management Accreditation COMMUNICATION - Aetna Applicable FARS/DFARS apply. Some subtypes have five tiers of coverage. (PDF) A Profile of Medicaid Managed Care Programs in 2010: Findings 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. NCQA Accreditation standards are intended to help organizations achieve the highest level of performance possible, and create an environment of continuous improvement. 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 . All services deemed "never effective" are excluded from coverage. In 2019, NCQA rated more than 1,000 health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. All Rights Reserved. Together with Autism Comprehensive Educational Services (ACES), weve created the first Aetna Institute of Quality (IOQ) for autism. If you do not intend to leave our site, close this message. 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. Purchase and review the program resources, conduct a gap analysis and submit your online application. 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. 0000007964 00000 n The accreditation process takes an average of 12 months and is the only healthcare industry program that bases results on clinical performance and consumer experience. 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. More than 173 million people are enrolled in NCQA-Accredited health plans. We shared the results with the National Committee for Quality Assurance (NCQA) Quality Compass. Request an application. Treating providers are solely responsible for medical advice and treatment of members. Issues a contract for insurance for a defined population or contracts with an employer to provide managed care services for a self-insured population. and Compliance, Evidence-Based Who do we contact to begin credentialing with UnitedHealthcare or its affiliates? 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. Kristine is based out of Ventura County, California, United States and works in the Hospitals and Health Care industry. Workgroup Charter Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Providers can receive the most effective, stress-free service. Create and deliver quality improvement, management or assessment programs and processes. 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). <<354B25B36AD9EC4CB456011F0DE50B5F>]>> Organizations that earn a seal from NCQA show that they are serious about quality health care. 3 months before the survey start date: an Accreditation Services Coordinator from NCQA will contact your organization. Explore health plan accreditation with Wellsource. 0000014217 00000 n By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation. The review process is rigorous and may consist of both an onsite and offsite evaluation. 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. 0000007276 00000 n In case of a conflict between your plan documents and this information, the plan documents will govern. 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 information is neither an offer of coverage nor medical advice. 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. NCQA Accreditation as of June 30, 2019. Review Handbook and Application. Pricing is based on multiple factors. 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. CVS Health Receives NCQA Utilization Management Accreditation 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. Employers, in turn, will benefit from increased productivity, lower absenteeism and, possibly, lower health care cost increases. If you are not currently accredited and want to learn more, contact NCQA. 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. OTHER NAMES FOR THIS HEALTH PLAN. Align your organization's processes with the CR standards. Applicable FARS/DFARS apply. So why do health plans do it? You are now being directed to CVS Caremark site. and achieving accreditation is a lengthy process, representing a lot of work. More people are using telemedicine. As a result, many MCPs already follow NCQA guidelines with regard to care coordination or population health management. Our quality improvement program helps improve the behavioral health care we provide to you. Members also told us the assistance they received helped them better manage their health, We surveyed members in the Aetna Disease Management program. If you dont see what youre looking for below, you can search NCQAs database of additional common questionsor ask a question through My NCQA. NCQA - NCQA - National Committee for Quality Assurance 0000018693 00000 n If you have questions about a Med Premier major medical plan, call The Boon Group at the toll-free number on your member ID card. NCQA accreditation standards help health plans and other organizations align future initiatives with issues that are front and center for employers and states. We updated our app and provider directory to help members easily find providers who offer telemedicine. I = Insufficient data; NC = No Credit; NA = Not Applicable . In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Health benefits and health insurance plans contain exclusions and limitations. ncqa, 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. xbbbd`b``l $ u Accreditations See our recognition from trade associations, regulatory agencies and other governing bodies. 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. New and revised codes are added to the CPBs as they are updated. This workgroup will provide input on topics related to the standards and processes of requiring all MCPs to obtain NCQA accreditation, including consideration of the proposed accreditation requirements. 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. Accreditation Status of Health Plans Report - California Treating providers are solely responsible for medical advice and treatment of members. This information is neither an offer of coverage nor medical advice. 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). The information you will be accessing is provided by another organization or vendor. Submit an inquiry through My NCQA. 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 .