Tag: #aetna

Posted in #aetna, Training, Updates

Aetna Better Health of Florida to pay for certain Z codes

Posted on by KR2Medical Billing

Do you or your office reports social determinants and accept Aetna Better Health members? Great news! Now according to an update sent to the physicians, the insurance plan will reimburse for certain Z codes that correspond to certain social determinants of health.

Some of these Social Determinants of Health include (not all included):

• Assistance reapplying for Medicaid benefits
• Transportation: ModivCare
• Cleaning: Pest control, carpet cleaning, house cleaning
• Housing Specialist: assist with housing searches, voucher applications, transitioning from institution to
community
• Member Advocates: assist with coordinating and access to community resources
• In-office care management support for provider or specialist visits
• Peer support specialist
• Disease management education
• Smoking cessation support services

The Z codes will be reimbursed when they are billed with code: G9919

Partial list of covered Z codes:

For full list of the covered Z codes that are covered, please click here.

Find this type of content useful, then follow my blog. Get your updated information about medical coding and billing guidelines, reimbursement/medical policies, prior authorization changes, etc.

Past Blog Posts:

Michigan Medicaid: reimburses for Doula Services-01/01/23

The new coverage policy applies to Medicaid, Healthy Michigan Plan, MI Health Link, MIChild, MaternityOutpatient Medical Services Programs. Effective 01/01/23 – Michigan Medicaid members that belong to the above mentioned programs will be able to receive services from a certified doula during the the prenatal, labor and delivery, and postpartumperiods. Doula- non clinical professional that…

by KR2Medical Billing

UHC NY Community Plan Referral requirement change-effective immediately

As per UniteHealthCare- NY community Plan -members will no longer require referrals to see specialists (most specialties). This change is made to help Primary Care Physicians with reducing administrative burden and make it easier for the members to see some specialists. The specialists that do or do not require a referral still need to be…

by KR2Medical Billing

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Posted in #aetna, #Medicare, #Medicareadvantage, Training, Updates

Aetna Medicare Advantage: participating providers’ post-service appeals new address

Posted on by KR2Medical Billing

Are you an Aetna Medicare Advantage participating provider and had issues with your post-service appeals? If your answer is yes, it is because as of Jan 1, 2022 there is a new address where the providers need to submit those appeals to.

There is also a NEW FORM that the provider needs to fill out.

Where to find the new form?

You can find this form, which is called the Medicare Provider Complaint and Appeal Request Form, by going to the forms for health care professionals page and scrolling to the “Dispute and appeals” drop-down menu.

The New form should be sent to the address below:

Medicare Provider Appeals PO Box 14835 Lexington, KY 40512 Fax: 1-860-900-7995

OLD ADDRESS IS NO LONGER VIABLE:

Provider Resolution Team PO Box 14020 Lexington, KY 40512 Fax: 1-800-624-0756

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Posted in #aetna, #Medicare, #Medicareadvantage, Training, Updates

Aetna and Mid Level Reimbursement EM Services update 2022

Posted on by KR2Medical Billing

According to Aetna June 2022 provider newsletter- Aetna will NO Longer pay for the mid level staff: nurse practitioners, physician assistants, certified nurse midwives and clinical nurse specialists, at 100%, if they are performing the following codes:

G0402-
Long description: Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
Short description: Initial preventive exam

G0438- Long description: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit

Short description: Ppps, initial visit

G0439- Long description: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

Short description: Ppps, subseq visit

Note to Washington State providers: Your effective date for changes described in this article will be communicated following regulatory review.

How can you access the full policy?

Log in to Availity*** and follow these steps:

  1. Click on Payer Spaces > Aetna.
  2. In the search box, type “mid-level practitioners” and click Search.
  3. Choose “Mid-level Practitioners and Other Qualified Health Care Professionals — Resource.”

This policy applies to Aetna commercial and Medicare members.

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#AETNA, #NP, #PA, #G0402