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Participating Provider Precertification List

Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutionsParticipating Provider Precertification ListEffective July 1, A (7/14)Reference general Precertification to: all aetna plans, except Traditional Choice plans; all Innovation HealthSM , 2 1. Inpatient confinements Surgical and nonsurgical Skilled nursing facility Rehabilitation facility Inpatient hospice (except Medicare) Maternity and newborn confinements that exceed the standard length of stay (LOS)3 2. Ambulance Transportation by fixed-wing aircraft (plane) Elective (non-emergency) transportation by ground ambulance or medical van for Medicare Advantage plan members only 3. Autologous chondrocyte implantation, Carticel 4 4. Cochlear device and/or implantation4 5.

www.aetna.com ©2014 Aetna Inc. 23.03.882.1 A (7/14) General information 1. Precertification and notification are the processes of collecting information before elective inpatient admissions and/or

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