A new online provider directory tool is now available to groups and their covered employees with a self-funded plan design that uses the Aetna Signature Administrators (ASA) PPO network. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 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 . The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Aetna Signature Administrators (ASA) PPO Network has a new provider directory tool, providing a better member experience when searching for providers on the site. You can also call Aetna Better Health ofNevada at 1-866-815-3732 or TTY 711 to request a hard copy of the Provider Directory. 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. Starting July1, State of NevadaPEBP members can use the Aetna Signature Administrators preferred provider organization program and medical network. The online Provider and Pharmacy Directory is updated at least every 30 days. 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. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. To help us direct your question or comment to the correct area, please select a category below. The member's benefit plan determines coverage. 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. By providing us with your email address, you agree to receive email communications from Aetna until you opt out of further emails. You'll find these doctors with the label "Quality Care," "Effective Care" or both in your search. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. To request participation in Coventry Workers' Compensation, Coventry Auto Injury, or First Health networks, follow the links below. Aetna's 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). 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. I may or may not be employed by an Aetna-contracted provider. It is important to note that not all of the Sutter Health network of providers necessarily participate in all of a health plan's products or networks. 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. The member's benefit plan determines coverage. This information is neither an offer of coverage nor medical advice. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Contact the customer service number on the back of your ID card. Read about members protections against surprise medical bills. The member's benefit plan determines coverage. Members should discuss any matters related to their coverage or condition with their treating provider. CPT only copyright 2015 American Medical Association. Aetna Inc. and its subsidiary 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. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Aetna Inc. and itsitsaffiliated 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. The Aetna Dental Administrator network is not applicable for HAP members. Enrollment Guides The member's benefit plan determines coverage. Aetna Inc. and its subsidiary 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. Ready to search our network? There is no obligation to enroll. 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. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). 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. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. 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. 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. Tennessee and WyomingUnitedHealthcareKansas ,Signature Minnesota, Administrators is GEHA's preferred network in California and Oregon through Dec. 31, 2021. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Well need to terminate your existing agreement with us. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. This search will use the five-tier subtype. 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. 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. Welcome to your Medicare plan A suite of benefits just for 1199SEIU retirees. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. CPT only copyright 2015 American Medical Association. 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. 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. You can narrow your Aetna provider search by filtering provider characteristics, geographic location and best matched. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. To begin a provider search, click on the Enter DocFind button below, and follow the screen prompts. First time log in will require providers to register to obtain a user ID and password. No fee schedules, basic unit, relative values or related listings are included in CPT. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. By clicking on I accept, I acknowledge and accept that: Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Aetna Inc. and its subsidiary 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. CPT only copyright 2015 American Medical Association. 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. 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. By continuing to use the site, you agree to the use of cookies. 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. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. I practice independently and I want to contract with Aetna. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Please log in to your secure account to get what you need. Read about members protections against surprise medical bills. Treating providers are solely responsible for medical advice and treatment of members. Unlisted, unspecified and nonspecific codes should be avoided. It is only a partial, general description of plan or program benefits and does not constitute a contract. While we strive to keep this list up to date, it's always best to check with your health plan to determine the specific details of your coverage, including benefit designs and Sutter provider participation in your provider network. 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. All Rights Reserved. Aetna providers in Michigan and Northwest Ohio are considered out of network for HAP members. You can now find support through our Aetna Signature Administrators preferred provider organization network. Please check with your health plan if you have questions about coverage and network providers for specific products. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Please select "Continue to ProVault to begin the contracting and credentialing process. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Each main plan type has more than one subtype. 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. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. CPT is a registered trademark of the American Medical Association. Enter your location details and click "Search." Select your PreferredOne Network in the "Search by Network" section 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 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. Want to know more about a provider? For language services, please call the number on your member ID card and request an operator. 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. Our TPA partnershandle all claims processing and claims questions. 2175 N. Glenville Drive Name, address and phone number of the pharmacy contact person, Name and title of the authorized agreement signer. Go to Aetna.com/ASA. ID cards for new and renewing groups will reflect the new website address. 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). LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). 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). This Agreement will terminate upon notice if you violate its terms. 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. This search will use the five-tier subtype. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Look no further. 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. Provider termination form and directory update. 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. We've established relationships with a limited number of payers. The AMA is a third party beneficiary to this Agreement. Each main plan type has more than one subtype. This search will use the five-tier subtype. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. I am a non-physician health care professional who wants to be available for selection as a primary care provider (PCP), and my state regulations allow me to serve as a PCP. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. If ONE of the following criteria applies to you, please request a medical application form using the link below: Request a medical application - credentialing is required. All Rights Reserved. Medical claims and Brand/Specialty prescriptions paid at 80/20 co-insurance rate (80% by insurance/20% by member) after HRA is exhausted and deductible has been met. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Alta Bates Summit Medical Center - Alta Bates Campus, Alta Bates Summit Medical Center - Summit Campus, Sutter Maternity & Surgery Center of Santa Cruz. About the TSHBP 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). Applicable FARS/DFARS apply. 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. The following hospital and/or physician groups accept Aetna Signature Administrators. 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. In case of a conflict between your plan documents and this information, the plan documents will govern. Links to various non-Aetna sites are provided for your convenience only. With our network, you have access to: Over 1.2 million participating doctors. Sutter Health is a registered **FOR EXTRA BENEFITS CARD: Check your Summary of Benefits to see if your Extra Benefits Card can be used for other things such as OTC items, transportation and utilities. The ABA Medical Necessity Guidedoes not constitute medical advice. All services deemed "never effective" are excluded from coverage. WPN Provider Search Printable PDF Version The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. These payers include leading third-party administrators and carriers. 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. Links to various non-Aetna sites are provided for your convenience only. Aetna Signature Administrators (ASA) PPO Network has a new provider directory tool, providing a better member experience when searching for providers on the site. Independent retail pharmacies can fill out the form at the link below. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. This Agreement will terminate upon notice if you violate its terms. Required fields are marked *. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). 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. Unlisted, unspecified and nonspecific codes should be avoided. Please be sure to add a 1 before your mobile number, ex: 19876543210, ASA and Meritain - use phone number on member's ID card, BRCA genetic testing (precertification and information) -, Mental health treatment - use phone number on member's ID card, Availity help - registration questions, help with user name/password, Substance abuse treatment - use phone number on member's ID card, I am a non-physician health care professional who is not employed by an Aetna-contracted provider (physician group, hospital, etc.) You'll find the payer ID (for electronic claims) and address . Of course, you can use our directories to find doctors and hospitals that take your insurance. Disclaimer of Warranties and Liabilities. TSHBP FAQ's WebTPA is actively monitoring the COVID-19 situation as it relates to our clients, members, partners and employees. To go to the website for Aetna Signature Administrators and search for a provider. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Members should discuss any matters related to their coverage or condition with their treating provider. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Let's get started! Aetna's 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). Please log in to your secure account to get what you need. Some subtypes have five tiers of coverage. Aetna Signature Administrators is a registered trademark of Aetna, Inc. Provider Search is provided solely for the personal, non-commercial use of current and prospective Aetna members and providers. No fee schedules, basic unit, relative values or related listings are included in CPT. This information is neither an offer of coverage nor medical advice. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Video Library, Texas Schools Health Benefits Program (TSHBP) As a result, the turnover in our network is remarkably low, year after year. Use this tool to find doctors, hospitals and other providers in the GEHA network. If you do not intend to leave our site, close this message. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Note: If you are a hospital based provider seeking to join an already contracted group, you do not need to complete the application independently. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The Aetna logo. 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. Your browser doesn't support JavaScript code, or you have disabled JavaScript. 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. Some subtypes have five tiers of coverage. Youll also find the phone number on the members ID card. The member's benefit plan determines coverage. The AMA is a third party beneficiary to this Agreement. 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. Provider directory You can also check your plan's provider directory for in-network providers. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Apply to join the workers' compensation network in New York. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. See what's covered Featured updates MDLIVE Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Exception: For workers' compensation network in Texas, do not apply online; instead, call 1-800-937-6824. Learn about Aetna Smart Compare You might be surprised what you can search for Thank you for choosing Aetna for your Medicare coverage. *$150 Emergency Room Copay, waived if admitted. No fee schedules, basic unit, relative values or related listings are included in CPT. CPT is a registered trademark of the American Medical Association. PPO Provider Locator. Find Doctors Find Locations Treatments & Services Accepted Health Plans Aetna - Aetna Signature Administrators Health Plan Search Aetna - Aetna Signature Administrators Please Note The following hospital and/or physician groups accept Aetna Signature Administrators. 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. You are now being directed to CVS Caremark site. 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. The ABA Medical Necessity Guidedoes not constitute medical advice. Employer groups can contact your HAP or HAA representative for more information. CPT only Copyright 2022 American Medical Association. Richardson, TX. Do you want to continue? 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. Disclaimer of Warranties and Liabilities. Aetna Inc. and itsitsaffiliated 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. You are now being directed to the CVS Health site. 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. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. Submit your claims directly to Allied through the Emdeon-Change Healthcare clearinghouse and get paid faster. Be sure to check your email for periodic updates. Treating providers are solely responsible for medical advice and treatment of members. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members.