The NCQA bases its general accreditation fee on a formula of $39,750 plus 16 cents per member if the plan's membership is over 50,000. Private Health Insurance Plan Ratings - NCQA Asthma drug management Did people, . 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. 1 Based on results from the 2021 Aetna Case Management Member Satisfaction Analysis. HRA, What is NCQA behavioral health? [FAQs!] - wellbeingport.com Save your favorite pages and receive notifications whenever theyre updated. 0000002555 00000 n Applicable FARS/DFARS apply. Such data can lead to the development of specific initiatives that improve the health of people of various backgrounds based on their risks for certain conditions. NCQA - NCQA - National Committee for Quality Assurance Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. MCG and Support for NCQA Accreditation - MCG Health All Rights Reserved. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. URL: www.aetna.com. PDF National Medicaid - Quality Management Accreditation COMMUNICATION - Aetna 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. 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. Aetna Better Health of Michigan, Inc., earns NCQA Health Equity Contact us at My.NCQA to ask about licensing the ratings data for research or display. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. Data leads to insight about member health needs, which strengthens our ability to develop targeted initiatives. health plans, Don Hall, DrPH, CHES, Founder Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. We piloted new programs to help members manage addiction, depression, anxiety and eating disorders. Some subtypes have five tiers of coverage. The NCQA process was Implemented effective 3/1 8/2020 by the Credentialing Department at Aetna Better Health of Louisiana. 70 0 obj <>stream If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. The issue of health care disparities is immensely complex, but there are targeted solutions that can help us bridge the gap. We developed Second Curve, Here4You and other suicide prevention campaigns to move beyond awareness and drive change. In 2019, NCQA rated more than 1,000 health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. Racial and ethnic equity FAQs | Aetna 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. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 45 26 0000001192 00000 n 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. CPT only copyright 2015 American Medical Association. The member's benefit plan determines coverage. 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. 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. All Rights Reserved. This certification signals our commitment to providing a best-in-class solution based on industry best practices and evidence-based research that will support health and improve outcomes. The accreditations come after Aetna Better Health of Michigan, Inc., participated in an eight-month NCQA sponsored pilot to develop its Health Equity Accreditation Plus evaluation program. 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. Success of our initiatives will be achieved if we can: In the end, true success will come when our members achieve improved health outcomes as a result of our targeted initiatives and programs. PDF DHCS Care Coordination Project: NCQA Accreditation - California Links to various non-Aetna sites are provided for your convenience only. Out of 26 MCPs in the state, 12 plans currently have NCQA accreditation, and four are pending an accreditation visit. 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. NCQA Health Plan Accreditation is a widely recognized, evidence-based program dedicated to quality improvement and measurement. The first step to earning accreditation is a discussion with an NCQA program expert. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Status. Wellsource:NCQA Certified, Committed toQuality andExcellence, Ready to learn more about the NCQA certification process? Ncqa Health Plan Rating 2022 It is only a partial, general description of plan or program benefits and does not constitute a contract. NCQA conducts the survey and determines your accreditation status within 30 days of the final review. (PDF) A Profile of Medicaid Managed Care Programs in 2010: Findings *NCQA-Accredited health plans or MBHOs are eligible for Accreditation in UM, CR or PN if they also maintain health plan or MBHO Accreditation. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". The standards focus on: Quality Management and Improvement Population Health Management Network Management 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. #IP#@w"+;#j}2%0Z2 Applicable FARS/DFARS apply. 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. 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. Your benefits plan determines coverage. If you are not currently accredited and want to learn more, contact NCQA. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. 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. 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. NCQA Health Insurance Plan Ratings 2019-2020 - Detail Report (Private) Plan Name: Aetna Life Insurance Company (Ohio) Rating: 3.5. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. What is NCQA Certification? - Verisys