According to Aenta- starting in December 1, 2020.
Aetna will require providers to request a prior authorization for non-emergent outpatient diagnostic left and right heart catheterization services. If prior authorization is denied or was not requested then ALL/ANY related angioplasty procedure will also be denied.
Please visit eviCore for the complete list of procedures that require an approval. (link)
How to request an authorization:
- Call 1-888-693-3211 (TTY: 711) (7 AM to 8 PM CT, Monday through Friday).
- Fax a request form (available online) to 1-844-822-3862.
- or go to eviCore website.
What about urgent requests?
If the patient needs the services done in less than 48 hours, please call eviCore customer services for a fastest review and inform them that this is an urgent request.
Keep in mind:
If you perform services without requesting a prior authorization, we (Aetna) may deny payment.
We (AETNA) base our final coverage decision on the applicable policy’s terms and conditions along with our policies and procedures.
If you have questions, call eviCore healthcare at 1-888-693-3211 (TTY: 711). Or you can call Provider Services at:
- 1-800-624-0756 (TTY: 711) for HMO and Medicare Advantage benefits plans
- 1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for all other plans
KR2 Medical Billing 