Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The member's benefit plan determines coverage. 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. 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. Members should discuss any matters related to their coverage or condition with their treating provider.Įach 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. The ABA Medical Necessity Guide does not constitute medical advice.
The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions.
#AETNA TIMELY FILING 2021 PLUS#
If you have any questions, call Aetna Assure Premier Plus (HMO D-SNP) atġ-84 (TTY: 711) Monday to Friday, 8 AM to 5 PM ET.īy clicking on “I Accept”, I acknowledge and accept that: More resources for you and your office staffĪetna Assure Premier Plus (HMO D-SNP) plan website Simply use the Medicaid Web Portal or select Aetna Better Health® in Availity® to see all the ways that we support you. You can use the provider portal to access eligibility, panel rosters, claims status and much more.Members should not be balanced billed for any covered benefit. Use submitter ID #46320 when submitting claims. Your claims will automatically be processed first under the Medicare benefits and then under the Medicaid benefits. Using the member’s ID number from the plan ID card, you will need to submit one claim.In-network primary care provider (PCP) selection required.A dedicated Aetna® care manager for all members.
It carries a $0 cost share for all members.Īs a participating provider in this new plan, you will want to be aware of the following: It covers all Medicare and Medicaid services, including prescription drugs, behavioral health, Managed Long Term Services and Supports (MLTSS) and additional supplemental benefits.
#AETNA TIMELY FILING 2021 FULL#
This is a Medicare Advantage managed care plan option for individuals with Medicare and full NJ Famil圜are/Medicaid coverage. On January 1, we launched Aetna Assure Premier Plus (HMO D-SNP), a new Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) in these New Jersey counties: New Medicare plan: Aetna Assure Premier Plus (HMO D-SNP) effective January 1, 2021
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