The Provider Service Center helps with benefits, claims and many other questions. 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. Before you give any personal information, initiate your own call to Medicare at 1-800-MEDICARE. Includes PPO, HMO, HMO-POS medical plans with or without drugs. Please log in to your secure account to get what you need. 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). Were bringing you to our trusted partner to help process your payments. Each main plan type has more than one subtype. Please log in to your secure account to get what you need. For language services, please call the number on your member ID card and request an operator. In case of a conflict between your plan documents and this information, the plan documents will govern. Write to us at Aetna Better Health of Ohio 7400 W. Campus Road New Albany, OH 43054 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. Got a rash and not sure what it is? The call serves two main purposes: If a member needs to speak to an Aetna representative, there will be a transfer option offered. The AMA is a third party beneficiary to this Agreement. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Treating providers are solely responsible for dental advice and treatment of members. License to sue 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. You are now being directed to the CVS Health site. Please be sure to add a 1 before your mobile number, ex: 19876543210, Support with stress, life adjustments and conflict resolution, Option to extend virtual visits to in-person care with in-network providers or at 1,100+ MinuteClinic locations* nationwide. When billing, you must use the most appropriate code as of the effective date of the submission. Each main plan type has more than one subtype. You can also call Aetna Member Services by calling the phone number on the back of your ID card. Im turning 65 or just starting to explore Medicare. 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. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. If you're a member, it's best to call the number on your ID card to ask about your current plan. *First Name. WebTelehealth Services for Aetna Members Care anytime, anywhere With our virtual care and telemedicine options, you can talk to a doctor by phone 24/7. 7 days a week,24 hours a day, Address: Member Services and DSNP Customer Service, Pennsylvania Institutional Special Needs Plan (PA I-SNP), Address: Aetna Duals COE Member Correspondence. Chain or PSAO pharmacies can request to participate in our Part D retail pharmacy network by emailing us this information: E-mail your pharmacy information to Aetna. full name (first and last name)address/zip code/email/etc. (you might need to provide some information to confirm your identity)date of birthsocial security numberhealth insurance policy numbermember number (Aetna member number)your billing information (if the question is about a bill) Includes PPO, HMO, HMO-POS medical plans with or without drugs. Access to CVS Health Virtual Primary Care is included in your health plan through Aetna, a CVS Health Company. The member's benefit plan determines coverage. Staff on the nurse call line cannot diagnose, prescribe or give medical advice. Virtual appointments available seven days a week. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 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. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. Credentialing and joining our network - 1-800-353-1232 (TTY: 711). 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. 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. Aetna SilverScript Prescription Drug Plans (PDPs) And making your next steps easier with a dedicated Care Team. 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. 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. Some subtypes have five tiers of coverage. The Appointment of Representative form is on CMS.gov. Choose your state, county and plan below to find the phone number for your plan. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. Then, have your visit within 72 hours from wherever you are. Simply choose a dedicated provider and get a supporting Care Team. Your InstaMed log in may be different from your Caremark.com secure member site log in. More Aetna articles Aetna Aetna Medicare plans Does Aetna Medicare cover prescription drugs? 1-877-543-6619 TTY users 711 (sneezes) Bless you. *For urgent and short-term care needs. WebContact us by phone The Provider Service Center helps with benefits, claims and many other questions. You are now being directed to CVS Caremark site. If you have questions about Medicare, call 1-800-MEDICARE (633-4227). Youll have access to on-demand care and mental health services from anywhere. Si tu intencin no era salir del sitio web, cierra este mensaje. You are now being directed to the CVS Health site. If you do not intend to leave our site, close this message. 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. This site has its own log in. Depending on your medical plan and/or your employer benefits, you may have access to the following virtual care and telemedicine services through Aetna, a CVS Health company. Get a virtual primary care appointment within days, not weeks. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Aetna members have access to contact information and resources specific to their plans. Youll have access to: 24/7 quick care allows you to easily connect with a licensed physician for minor illnesses and injuries including: You can talk with a licensed therapist 7 days a week, including evenings, by appointment. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. Froma24-hour nurse line to vision and fitness, youre covered. If you do not intend to leave Aetna Medicare, 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. All services deemed "never effective" are excluded from coverage. To view the form just select Continue. 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. It is only a partial, general description of plan or program benefits and does not constitute a contract. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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. Applicable FARS/DFARS apply. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. A Medicare recipient will get a phone call from someone claiming to work for the Center of Medicare and Medicaid Services, the Social Security Administration or an insurance provider. All services deemed "never effective" are excluded from coverage. 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. 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). No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. [Narrator] Virtual care, telehealth. [Care professional] I'm really glad that you reached out. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Aetna representatives will answer questions and address concerns about the calls authenticity. Care for minor illnesses, mental health and more. I tell everyone who is having a 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). Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. 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). If you do not intend to leave our site, close this message. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Aetna handles premium payments through Payer Express, a trusted payment service. 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. It is only a partial, general description of plan or program benefits and does not constitute a contract. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Do not respond if you get a call, text or email about free coronavirus testing. Staff on the nurse call line cannot 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. Review the enrollment checklist with 4 to-do's before you choose a health plan. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Convenient and affordable care wherever you need it. It's on-demand care, wherever you need it. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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. Treating providers are solely responsible for medical advice and treatment of members. Teladoc is not available to all members. If you do not intend to leave our site, close this message. Thank you so much. [Virtual care professional] It's my pleasure. If you do not intend to leave Aetna Medicare, close this message. 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. Aetna handles premium payments through InstaMed, a trusted payment service. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 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. Copyright 2015 by the American Society of Addiction Medicine. Why choose ${company} Medicare Solutions? If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. It may be different from your Aetna secure member site log in. Medicare Supplement Insurance plans. Copyright 2015 by the American Society of Addiction Medicine. If you do not intend to leave our site, close this message. I'm glad you contacted us. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Disclaimer of Warranties and Liabilities. All fields marked with an asterisk (*) are required. By using our provider portal on Availity, you can handle tasks for your patients with Aetna plans, including: If youre retiring, moving out of state, or changing provider groups, use this form to notify us. The information you will be accessing is provided by another organization or vendor. Your benefits plan determines coverage. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. This information is neither an offer of coverage nor medical 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. Treating providers are solely responsible for dental advice and treatment of members. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Why choose ${company} Medicare Solutions? Since Dental Clinical Policy Bulletins (DCPBs) 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. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. If you do not intend to leave our site, close this message. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. If you do not intend to leave our site, close this message. Apple, the Apple logo, iPhone and Apple Watch are trademarks of Apple Inc., registered in the U.S. and other countries. Applicable FARS/DFARS apply. If you do not intend to leave our site, close this message. Medicare coverage for the whole you body, mind and spirit, Discover coverage that takes a total approach to health, See how we help you get the right resources and care, Take full advantage of everything your plan offers you. Your InstaMed log-in may be different from your Caremark.com secure member site log-in. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. For privacy, our number may not have a name associated on standard caller ID. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional.