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. Oncology treatment plans must be submitted to NantHealth via their web portal, Eviti Connect, which will expedite clinical review of any chemotherapy, radiation therapy, or supportive medications that require prior-authorization. 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. 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). Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. If English is not your preferred language and you need help communicating in your preferred language, you may call 888-703-6999 to ask what language services are available to you. 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. Find A Dentist - DentaQuest All services deemed "never effective" are excluded from coverage. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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. Find a Doctor :: State of Illinois - Aetna All services deemed "never effective" are excluded from coverage. For non-participating health care professionals. Our directory PDF (or printed directory) is updated monthly.You can get a copy of the provider directory by mail. To help us direct your question or comment to the correct area, please select a category below. 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 Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Find your plan listed below and click Find a Dentist. Applicable FARS/DFARS apply. If your health benefit plan offers the Aetna Signature Administrators (ASA) PPO Network, use its online directory to search from approximately 1.4 million Aetna in-network providers and more than 6,000 hospitals nationwide. Links to various non-Aetna sites are provided for your convenience only. If you have questions, visit our contact us page. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Links to various non-Aetna sites are provided for your convenience only. Treating providers are solely responsible for medical advice and treatment of members. Aetna Medicaid collaborates with providers to deliver care that meets cost and quality goals. Due to the impact of the COVID-19 pandemic, many provider offices may need to adjust their office hours or redirect patients to others offices. Providers may not balance bill members who do not have cost-share responsibility (including QMB-only). You start saving within 72 hours of joining a plan (no long waits before you , https://www.aetnadentaloffers.com/find-a-dentist, Health (1 days ago) WebAetna Smart Compare is a designation we give to doctors in our network who have proven time and again that they provide high-quality, effective care. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Enter Location The DSNP network is in limited counties. . Do you want to continue? You can email your search results or print them. Links to various non-Aetna sites are provided for your convenience only. Avsis provides vision and dental claim and administrative services by agreement with Aetna Inc. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Network applications (behavioral health, dental, facility, and pharmacy) Practice changes and provider termination. If you do not intend to leave our site, close this message. If you are in New Jersey, check your status by going to the Aetna Assure Premier Plus provider search page. If you do not intend to leave our site, close this message. 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). Find a Provider | Aetna Medicaid In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. To check that your provider participates, visit our website or call us. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Aetna Better Health Dental Provider Be sure to check your email for periodic updates. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Others have four tiers, three tiers or two tiers. You may opt out at any time. you can call Aetna Better Health of Louisiana Member Services at 1-855-242-0802, TTY 711, 24 hours a day, 7 days a week. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. The ABA Medical Necessity Guidedoes not constitute medical advice. If you are looking for a specific provider and cannot find them online, need more information,help, or would like a printed copy of the provider directory mailed to you,callus at 1-855-242-0802, TTY 711, 24 hours a day, 7 days a week. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Health Insurance Plans | Aetna Looking for a local dentist? Applicable FARS/DFARS apply. Dental Savings Plans reduce the cost of dental care by 10%-60%, at thousands of participating dentists and dental specialists nationwide. 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. Please be sure to add a 1 before your mobile number, ex: 19876543210. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. NJ FIDE-SNP members will have one member ID card for both Medicare and Medicaid. Others have four tiers, three tiers or two tiers. 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. Links to various non-Aetna sites are provided for your convenience only. Please confirm with the provider when you call them. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Treating providers are solely responsible for medical advice and treatment of members. *Search by : Provider ID (PIN) NPI. New and revised codes are added to the CPBs as they are updated. Please refer to your Summary Plan Description (SPD) for an outline of your plan's covered benefits . Members should discuss any matters related to their coverage or condition with their treating provider. You also can look for more than 25 other types of health care providers, including pharmacies, marriage counselors, urgent care centers, acupuncturists, drug and alcohol counselors, hospice care providers, dialysis centers, vision care providers, flu shot providers and physical therapists. Do you want to continue? Or they can help you find a provider. PA requirements are both Yes and No, as specified on the PA List. 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. No fee schedules, basic unit, relative values or related listings are included in CPT. and you keep saving there is no maximum annual spending limit! ALL inpatient confinements require PA and usually ALL services provided . Please consult with the respective plan detail page for additional plan terms. Contact Us - Health Care Providers - Aetna Links to various non-Aetna sites are provided for your convenience only. In-network coverage only (except emergency . 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. Links to various non-Aetna sites are provided for your convenience only. LIBERTY makes certain language assistance services available to you at no cost. Aetna Inc. and itsaffiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. 2020 Guardian. Family planning, Emergent and Urgent Care services do not require PA. 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. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Exception Detail, Svc Partner Detail - When the. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Some subtypes have five tiers of coverage. Prior Authorization may be required. Pharmacy prior auth phone number: 1-855-221-5656. We update our provider directory nightly. Note not all Aetna dental plans and offers available in all markets. It provides coverage for a wide range of dental services, including . 1. Experience and expertise to help our customers and members navigate the complex global health care landscape. YES - Prior authorization request is required for this service. 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. 1999- Disclaimer of Warranties and Liabilities. 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. ProPAT CPT Code Lookup : Aetna Better Health Endodontists: help heal infections of the soft tissue inside the tooth and are typically the dental specialist youd see if you need a root canal treatment. Hospitals, long-term care facilities and skilled nursing facilities for rehabilitation, mental health facilities, Federally Qualified Health Centers and Rural Health Centers. . You are now being directed to CVS Caremark site. Each main plan type has more than one subtype. System (HCPCS) codes or a CPT group and select SEARCH. No fee schedules, basic unit, relative values or related listings are included in CPT. Treating providers are solely responsible for dental advice and treatment of members. Aetna international | International Medical Insurance Please log in to your secure account to get what you need. 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. This Aetna provider directory includes all Aetna participating providers, including both medical providers and dental providers. Please review the plan benefit coverage documentation under the link below. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. A new version of our find a dentist tool is now available for Illinois members! Aetna offers health insurance, as well as dental, vision and other plans, to meet the needs of individuals and families, employers, health care providers and insurance agents/brokers. Applicable FARS/DFARS apply. Find a Doctor, Dentist or Hospital | Aetna If you have any questions about authorization requirements or need help with the search tool, contact Aetna Better Health Provider Relations at 1-855-364-0974. 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. Visit the secure website, available through www.aetna.com, for more information. Reprinted with permission. All Rights Reserved. To search for a dentist, please choose a state, your plan and enter the zip code under the Enter Your Geographic Area section. You can get a copy of the provider directory by mail. CPT is a registered trademark of the American Medical Association. Each plan has its own provider network. Unlisted, unspecified and nonspecific codes should be avoided. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Our find a dentist tool includes a brief survey to help us improve this service. 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 medical advice and treatment of members. Dentists and dental office professionals, log in to Aetna Dental to handle claims, find forms, stay ahead of policy changes and more. Treating providers are solely responsible for medical advice and treatment of members. 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. CPT only Copyright 2022 American Medical Association. We encourage you to check with your participating provider prior to beginning treatment. CMS requires providers to take the Model of Care training course (PDF). The NJFC Directory of Dentists Treating Children under the Age of 6. Or they can help you find a provider. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Need a new dental office home? 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. License to use 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. Just call Member Services at 1-866-329-4701 (TTY: 711) to learn more about these services. Aetna Provider Search - Small Business Benefits | Trustmark The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. 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. Helping you find the right doctor for you. 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. Some subtypes have five tiers of coverage. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The information you will be accessing is provided by another organization or vendor. Provider manuals | Manuals | Aetna Better Health of Pennsylvania You can use the links below to find in-network providers and pharmacies nearyou. Members should always contact the provider's office in advance to confirm availability. Go to the American Medical Association Web site. Learn more about our dental advantages. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Click here to find an in-network dental provider thats close to you. Links to various Aetna Better Health and non-Aetna Better Health sites are provided for your convenience. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. 2023 DentalPlans.com, Inc. All Rights Reserved. Aetna Inc. and its affiliated companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. CPT is a registered trademark of the American Medical Association. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). AetnaDentalOffers.com is brought to you by DentalPlans.com. Unlisted, unspecified and nonspecific codes should be avoided. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Aetna has one of the nation's largest dental networks, with more than 200,000 participating dental practices, making it easy to find a great dentist or specialist near you. 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. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. 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. Depending on the members MSP eligibility, they may have a cost-share responsibility. Need a new dental office home? Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. For enhanced adults benefit, visitDental Provider Searchto view your dental providers. The member's benefit plan determines coverage. logo Aethna Better Health of West Virginia. You can all Member Services at 1-866-638-1232, TTY PA Relay 7-1-1 , TTY 711, for help finding a provider. You can further filter the search results by adding a specific dentists name and/or the type of dental specialist you wish to see. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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). When making an appointment, please be sure your provider offers all services you may need, Avsis Incorporated and Avsis Third Party Administrators, Inc. (Avsis), are wholly owned subsidiaries of Guardian. Search results are not a guarantee of claim payment. 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. list of CPT or HCPCS codes to only those requiring PA, please check the box labelled Include only CPT or HCPCS codes where PA is required?. Aetna Smart Compare is a designation we give to doctors in our network who have proven time and again that they provide high-quality, effective care. 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. The information you will be accessing is provided by another organization or vendor. Directory of Dentists Treating Members with Intellectual . Aetna better health florida healthy kids. Besides treating dental conditions, she educates her young patients on the importance of proper dental health and dispenses practical advice on maintaining dental hygiene. Aetnamedicare.blob.core.windows.net. Were expanding our DSNP program into more markets for 2022. Benefit coverage may vary by plan or may be subject to special conditions. Thanks! Some plans exclude coverage for services or supplies that Aetna considers medically necessary. This information is neither an offer of coverage nor medical advice. Copyright document.write(new Date().getFullYear()) Aetna Better Health of Louisiana, All Rights Reserved. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Provider Directory. 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. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Health benefits and health insurance plans contain exclusions and limitations. DocFind - Aetna Aetna Better Health of Illinois is not responsible or liable for non-Aetna Better Health content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Request an Office Transfer. Go to the American Medical Association Web site. You can also get the materials you need in a different language or format. Please correct the following errors and try again: Fill out the form below to find providers and healthcare facilities near you. 2020 Avsis Incorporated. Some subtypes have five tiers of coverage. To reduce the Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 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. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Find a Doctor, Dentist or Hospital | Aetna WebAetna Better Health of Maryland Medicaid Dental Provider Search. CPT is a registered trademark of the American Medical Association. License to use 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.

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