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At a glance - Aetna

Quality health plans & benefits Healthier living Financial well-being Intelligent solutions A quick reference guide for health care professionals Aetna at a glance F (4/18). A guide for doing business with Aetna Communications 2 Communications Sign up to receive electronic communications from Aetna , Our website 3 including OfficeLink UpdatesTM, our provider newsletter. It is published quarterly March 1, June 1, September 1 and December 1. This newsletter can include changes to policies Aetna Support Center 3 that may have an impact on your practice or facility. Log in to our provider website and select Aetna Health Plan . Tools and transactions 4 from the workflow menu. Choose Email Options, then Share Email Address. Enter your email address and review Claims information 5 the Email Acknowledgement. Note: OfficeLink Updates is only available by email or through Contact information 6 the Health Care Professionals section of , unless you have a specific need (for example, your office does not have Internet access).

Tax identification number (TIN) • Physician name, group name or hospital name ... Aetna Office Manual for Health Care Professionals — your guide to working with us. ... of payers. • To view a list of our participating claims vendors, visit .

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Transcription of At a glance - Aetna

1 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions A quick reference guide for health care professionals Aetna at a glance F (4/18). A guide for doing business with Aetna Communications 2 Communications Sign up to receive electronic communications from Aetna , Our website 3 including OfficeLink UpdatesTM, our provider newsletter. It is published quarterly March 1, June 1, September 1 and December 1. This newsletter can include changes to policies Aetna Support Center 3 that may have an impact on your practice or facility. Log in to our provider website and select Aetna Health Plan . Tools and transactions 4 from the workflow menu. Choose Email Options, then Share Email Address. Enter your email address and review Claims information 5 the Email Acknowledgement. Note: OfficeLink Updates is only available by email or through Contact information 6 the Health Care Professionals section of , unless you have a specific need (for example, your office does not have Internet access).

2 In Laboratory information 6. these instances, you will have the option to receive a printed version upon request. Provider webinars 7. Northeast Region 8. Mid-America Region 10. Southeast Region 12. West Region 14. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates ( Aetna ). 2. Our website Resources You can reduce the amount of time you spend on For your convenience, a list of the most commonly used tools administrative tasks by using Aetna 's provider website. You'll and resources is available for quick access upon logging in to have access to the information you need when you need it. our site. To access our website, go to and click Precertification Code Search Tool Log In/Register, then under Medical Professionals, choose Aetna 's Clinical Policy Bulletins (CPBs) are detailed and Log In or Register.

3 Technical documents that explain how we make coverage decisions for members under our health benefits plans For successful registration, you will need: Tax identification number (TIN) Aetna Support Center Physician name, group name or hospital name Clinical resources Email address Aetna Health ConnectionsSM disease management Primary office location programs, which provide educational materials and, in some When interacting with Aetna online, you'll be using NaviNet , cases, individualized case management for members with a free, multipayer, web-based system for administrative chronic health conditions. The programs focus on health transactions. You can use the available tools and resources education and behavior modification for modifiable risks. to access information quickly without having to pick up the Aetna Women's HealthSM programs and policies provide phone.

4 Detailed information about Aetna 's gynecologic and Website security officer obstetric programs and policies. This includes information on our maternity program, infertility program, BRCA. Upon registration, it will be necessary to designate a NaviNet Genetic Testing Program, Obstetric Ultrasound security officer for your office. The security officer will act as Enhancement Program and Non-Stress Test Enhancement the primary contact with NaviNet and will also monitor and Program. assist the NaviNet users in your office. To learn more about the security officer role, visit Doing business with Aetna If some of the tools in NaviNet can't be seen, please contact Aetna Benefits Products an easy-to-use guide that your security officer for access. There are some transactions provides basic Aetna benefits product information, that must be enabled by the security officer.

5 Including primary care physician (PCP) selection and referral requirements. Need help? Office manual for Health Care Professionals your For registration questions or log-in/password assistance, guide to working with Aetna . This reference tool acts as our call 1-888-482-8057, Monday Friday, 8 11 ET, provider manual , including local information that pertains and Saturday, 8 3 ET, closed Sunday. to your practice. Our Member Rights and Responsibilities are NaviNet offers several helpful online support tools: also included in the manual . On-screen help to walk you through each step of a Forms Library transaction Electronic remittance advice (ERA)/electronic funds transfer Step-by-step transactional and Aetna user guides (EFT) enrollment forms Online training demonstrations BRCA prior authorization forms Lab selection forms Important announcements Member health information forms/charting aids This area on the Aetna Plan Central home page is used to communicate time-sensitive information that may affect Pharmacy how you do business with Aetna .

6 Formulary information Pharmacy Clinical Policy Bulletins Aetna Specialty Pharmacy program e-Prescribing 3. Tools and transactions - Policy Information to find policy-related links if you are searching for general information on a topic or if you do Eligibility not have a specific procedure code Use the Eligibility and Benefits inquiry to obtain member- specific plan details. Transaction response fields include Claim EOB Tool (field may vary according to plan details): This tool allows providers and office staff to access claim Copay, deductible and coinsurance Explanation of Benefits (EOB) statements online within 24 hours of claims processing. You may also use this tool for Exclusions and limitations claims reconsiderations. There are multiple ways to search Visits used and visits remaining for an EOB using this tool: Referral and precertification requirements Access a daily list of EOBs Ability to view and print digital member ID cards*.

7 Search by a claim Tips when completing the Eligibility and Benefits inquiry: Search by an individual patient You may search using the patient's last name, first name Search by a payment (includes EFT trace number, check and date of birth if you don't have the member ID number number or dollar amount). Use the Benefit Type drop-down box to narrow down to Search by an individual provider a specific benefit (for example, Code 30 is for general Be sure to have your security officer enable the transaction benefits, Code 47 is for hospital benefits and Code 98 . View EOBs All TINs/Locations so that you can view all is for professional physicians and other services). of your EOBs. Access your Managed Choice /Elect Choice plan member roster and your HMO capitation and member rosters under Account management tools the Eligibility link. For additional reporting capabilities and submitting claims reconsiderations, you can use the suite of account Payment Estimator Tool management tools: The Payment Estimator enables you to request an estimate Claim History Report (which allows you to identify of your patient's financial responsibility on or prior to a date specific codes).

8 Of service. Single or multiple claim reconsideration Learn Aetna 's estimated payment amount. Get reliable estimates of the patient's copayments, Referrals coinsurance and deductibles. If a plan requires a referral, one should be issued from the Access printable information to help you initiate financial PCP for all specialist visits, including visits in a hospital clinic. discussions with your patients prior to or at the time of care. Referrals may be issued for consultation and treatment by Reduce, and potentially eliminate, after-the-fact financial using CPT 99499. surprises for you and your patients. Referrals are valid for one year, and the first visit must be The clearinghouse Availity also offers a version of the tool used within 90 days. known as Patient Cost Estimator SM ( ). A diagnosis code is not required; however, it is very helpful for the specialist.

9 Claims Direct access: Referrals are not required for routine eye care Aetna offers a wide variety of tools to help you manage and ob/gyn services. Refer to the Health Care Professional your patient accounts: Toolkit for additional direct-access specialties in your area. Professional Claims Submission (including Aetna A referral is not a substitute for a service that requires secondary claims) precertification. Claim Status Inquiry (checking the status of one single Referrals may be issued to an individual specialist using patient) his or her national provider identifier (NPI) or to a specialty Claim Status Report (checking the status of all your patients by using the taxonomy code. within a date range) Our DocFind online referral directory can be used to Fee Schedule (most directly contracted physicians [MD/DO] find a participating provider. can access their negotiated rates for CPT and HCPCS codes) Automatic Studies by specialty services performed Claims and payment policy tools in a specialist office when patients are seen for visits - Code Editing Tool, Clinical & Payment Policy Lookup to and evaluations as a result of our direct-access programs determine how procedure codes billed by themselves or when authorized by a referral from their PCP.

10 Or in combination with other procedure codes may be processed and to determine eligibility of an assistant surgery procedure *Your security officer must enable this feature for you. 4. Precertification Claims submission tips Use our online tools to help you determine if precertification To ensure accurate and timely claims payment, is required for a particular procedure, and submit please be sure to: precertification requests for those services. Review rejection reports from your vendor Precertification Code Search Tool allows you to enter up Correct and resubmit rejected claims electronically to five CPT codes at a time to quickly determine whether a through your vendor medical precertification is required for your patient. Ensure the member/patient name and ID numbers Online Precertification Transaction allows you to add a are correct precertification request for those services that require it and Ensure CPT and diagnosis codes are valid inquire to see if a precertification has been authorized.