Behavioral Health Provider Manual - Aetna

1 Behavioral Health Provider Manual June 2010. E (5/10). Table of Contents 1-2. Network 3-5. Clinical 6-11. Quality 12-15. Aetna Provider 16-17. Attachment A: Level of Care Assessment Tool Attachment B: Treatment Record Review Criteria and Best 19-21. Introduction Welcome to the Aetna or disease; (c) not primarily for the What you'll find in Behavioral Health network! convenience of the patient, physician this Manual We are pleased to serve as or other Health care Provider ; and We developed this Manual with you a major contributor in the (d) not more costly than an in mind giving you what you Behavioral Health care field. alternative service or sequence of need to work with us and ease your services at least as likely to produce administrative burdens.

2 Our Behavioral Health equivalent therapeutic or diagnostic programs focus on the results as to the diagnosis or treatment This Manual contains increasing role of mental of that patient's illness, injury or information about: Health on a person's overall disease. For these purposes, generally Network participation well-being. accepted standards of medical Specialty programs . practice means standards that are We look forward to working based on credible scientific evidence Outpatient Care Management . with you and will provide published in peer-reviewed medical Program you with tools to help you literature generally recognized by Credentialing/recredentialing . provide high-quality service the relevant medical community, or Site visits and monitoring.

3 To Aetna members. otherwise consistent with physician specialty society recommendations Contact information/how to . Our guiding principles and the views of physicians practicing reach us in relevant clinical areas and any other Clinical Practice Guidelines . Our Behavioral Health programs support relevant factors. Authorization and referral our belief in the following: . Educating members about the risks processes Enhancing our members' your . and benefits of available treatment Member and Provider denials . patients' experience. options. and appeals Adhering to the importance of the . Developing a strong relationship Case management . mind-body principle and connection. with you, informing you about Quality programs . Providing a treatment approach that available resources, and concentrating Working with Aetna electronically.

4 Is evidence based, goal directed and on the importance of continuity and much more! consistent with accepted standards of of care among all Behavioral Health care, all Aetna Clinical Policy Bulletins, professionals, for the benefit of your and Aetna Clinical Practice Guidelines. patients and you. Providing treatment that is medically Integrating Behavioral Health care . necessary according to the following across our product spectrum. definition: Medically necessary services are those Health care services that a practitioner, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are (a) in accordance with generally accepted standards of medical practice; (b) clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient's illness, injury 1.

5 Resources and staff How to find this Manual online Our medical directors and staff are always available to speak with you, and We update this Manual as we are committed to providing you needed to ensure you have the most with the tools, education and resources up-to-date, accurate information. needed to easily work with us. If you are not currently viewing this document online, you can find it by Aetna Behavioral Health medical logging in to our secure Provider website directors make all final coverage* denial via NaviNet at , determinations involving clinical issues. selecting Health Care Professionals, . If a treating Provider does not agree with then Medical Professionals Log In . a decision regarding coverage or would under Secure Site Log In.

6 Like to discuss an individual member's Already registered? Go to case, Aetna Behavioral Health medical Once on directors are available 24 hours a day, our Provider website, select Aetna 7 days a week, to discuss specific Support Center, Doing Business with concerns and provide additional Aetna , then Aetna Benefit Products . information. If you have questions about and Aetna Behavioral Health and coverage decisions for one of your Aetna Employee Assistance Program.. Behavioral Health patients, please call 1-888-632-3862. If you would like a hard copy Aetna Behavioral Health utilization of this Manual or any management (UM) staff are available at information contained in least eight hours per day for UM issues. this Manual , and do not have *For these purposes, coverage means Internet access, please call either the determination of (i) whether or our Provider Service Center not the particular service or treatment is a covered benefit under the terms of the at 1-800-624-0756 (for particular member's benefits plan, or (ii) HMO-based and Medicare where a physician or Health care professional is required to comply with Aetna 's patient Advantage plans) or management programs, whether or not the particular service or treatment is payable 1-888-MD Aetna .

7 Under the terms of the Provider agreement. (1-888-632-3862) (for all other plans). 2. Network Participation Aetna 's Behavioral Health We thank you for considering Using the BHA, patients are able Specialty Programs these exciting programs as additional to get information and identify care options for your eligible emotional or mental Health issues Our Behavioral Health Specialty Aetna patients. they are experiencing. Patients may Programs, including case management give their providers on-line access to and disease management, help our Aetna 's Behavioral these assessment results. Providers members achieve optimal wellness Health Outpatient Care can then use this information by supporting their medical and Management Program to develop a treatment plan and psychological needs.

8 Patients monitor a patient's progress. who complete these programs The purpose of Aetna 's Outpatient Care have been shown to have Management Program is to support This information may also significant symptom relief and physicians and Health care professionals, help to determine a patient's improvement in overall Health . and improve outcomes for patients appropriateness for one of Aetna 's with particularly complex Behavioral disease management programs Our specialty programs range Health conditions. Patients selected for (Medical Psychiatric Case from Medical Psychiatric Case participation are identified through a Management, Depression Disease Management to Alcohol, Depression screening process involving evaluation Management, Eating Disorders and Anxiety Disorder Disease of Behavioral , medical and pharmacy Case Management, Intensive Case Management programs.)

9 We've data. Using American Psychiatric Management, Bipolar Disease Case created a handy one-page summary Association (APA) Practice Guidelines Management, Alcohol Disease detailing our Behavioral Health and the latest evidence-based Management and Anxiety Disease Specialty Programs to help you approaches, Aetna 's multi-disciplinary Management). These programs: and your patients learn more and team of Health care professionals work benefit from these programs. rovide information to your P. with you to enhance patient outcomes. patients about their mental To view or print a PDF: This team includes psychiatrists, clinical Health issues. Visit and log in psychologists, social workers and a to our secure Provider website. registered nurse. S upport your patients in making Online Behavioral Health appointments and following your S elect Aetna Support Center then Assessment treatment plan.

10 Clinical Resources from the Aetna Plan Central home page. Some of your patients may be elp your patients locate H. concerned about anxiety, depression additional resources in the hoose Clinical Resources for C or other issues but are unsure about community. Physicians and Their Patients. whether they need professional help or resources. Aetna Behavioral Health elp your patients make optimal H. Scroll to Behavioral Health .. offers an interactive, online Behavioral use of their benefits package. lick on the Aetna 's Behavioral C Health Assessment (BHA) to support All of these activities are conducted Health Specialty Programs Flyer link. members and providers in the in accordance with applicable state Or, if you would like a paper copy treatment of Behavioral Health issues.