Category: #Medicareadvantage

Since 08/01/2021 Aetna has partnered with myNEXUS, a technology-enabled care management company, to manage the network, claims payment and precertification/prior authorization program for home health services.

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Note the following changes for the Providers:

Prior approval changes:

1. Effective for DOS 01/01/2022 and thereafter, myNEXUS will require advance approval for all home-health-related requests for in-home skilled nursing, physical therapy, occupational therapy, speech therapy, home health aide, and medical social work.
2. If you would like to view the full home health care pre-auth list, please click here (insert link)

Claim Payment and Processing changes:

1. Effective for DOS 01/01/2022 and thereafter, myNEXUS will pay claims for covered home health services, for Kentucky, Ohio and Missouri Medicare Advantage members
2. Reimbursement rates will correspond to the rates and terms of your myNEXUS contract.

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Important!

1.These above changes apply only to the Aetna Medicare Advantage Members that reside in the three states, and/or Aetna Medicare Advantage DSNP members, in the above mentioned 3 states.

2. These changes DO NOT APPLY TO THE FOLLOWING:

Medicare members residing outside of the states of Kentucky, Ohio and/or Missouri

Aetna and Coventry commercial fully insured HMO/POS/PPO plans • Aetna administrative services only (ASO) self-funded HMO/POS/PPO plans

Aetna Student Health℠

Aetna Global Business • Coventry Workers’ Compensation  

Cofinity®

First Health®, Meritain® Health, Traditional Choice®

Aetna Signature Administrators® 

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Where do I order a prior approval?

1. Online: myNEXUS portal to get started or

2. Fax the authorization request form to 1-866-996-0077

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Find this type of content helpful? Follow my blog for more payer network news, medical billing and coding updates, reimbursement/medical policy changes.

Recent Blog Posts:

---

• Fidelis MMC: healthy nutrition benefit
• UHC Medicaid: Idaho: diabetic DME coverage change-benefit
• Anthem BCBS: 32BJ fund new TPA and cards
• Are you leaving revenue on the table?
• Current facia plane block codes

Since 08/01/2021 Aetna has partnered with myNEXUS, a technology-enabled care management company, to manage the network, claims payment and precertification/prior authorization program for home health services.

---

Note the following changes for the Providers:

Prior approval changes:

1. Effective for DOS 01/01/2022 and thereafter, myNEXUS will require advance approval for all home-health-related requests for in-home skilled nursing, physical therapy, occupational therapy, speech therapy, home health aide, and medical social work.
2. If you would like to view the full home health care pre-auth list, please click here (insert link)

Claim Payment and Processing changes:

1. Effective for DOS 01/01/2022 and thereafter, myNEXUS will pay claims for covered home health services, for Kentucky, Ohio and Missouri Medicare Advantage members
2. Reimbursement rates will correspond to the rates and terms of your myNEXUS contract.

---

Important!

1.These above changes apply only to the Aetna Medicare Advantage Members that reside in the three states, and/or Aetna Medicare Advantage DSNP members, in the above mentioned 3 states.

2. These changes DO NOT APPLY TO THE FOLLOWING:

Medicare members residing outside of the states of Kentucky, Ohio and/or Missouri

Aetna and Coventry commercial fully insured HMO/POS/PPO plans • Aetna administrative services only (ASO) self-funded HMO/POS/PPO plans

Aetna Student Health℠

Aetna Global Business • Coventry Workers’ Compensation  

Cofinity®

First Health®, Meritain® Health, Traditional Choice®

Aetna Signature Administrators® 

---

Where do I order a prior approval?

1. Online: myNEXUS portal to get started or

2. Fax the authorization request form to 1-866-996-0077

---

Find this type of content helpful? Follow my blog for more payer network news, medical billing and coding updates, reimbursement/medical policy changes.

Recent Blog Posts:

---

• Fidelis MMC: healthy nutrition benefit
• UHC Medicaid: Idaho: diabetic DME coverage change-benefit
• Anthem BCBS: 32BJ fund new TPA and cards
• Are you leaving revenue on the table?
• Current facia plane block codes