I am always excited to read AAPC Healthcare Business Monthly Magazine. However for the Month of November 2021, I extra exited, because my article (see below) was published! Proud of being part of AAPC!
Aetna considers only a panel of 25 core mutations that are recommended by the American College of Medical Genetics, medically necessary, for Cystic Fibrosis screening. Anything cystic fibrosis mutations that extend beyond the recommended core panel of mutations, will not be covered and be deemed as investigational.
To read the full medical/reimbursement policy for Genetic Testing , please click here.
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Recently, while I was preparing for my Denials Management Made Easy Webinar (Physician Services), coming soon, I researched the 8 most common denial types.
One of those common denials is timely filing.
Timely filling frame is the time given to providers to send their clean claims to the insurance payer. Each insurance payer has different timely filling time frames. These time frames also differ for In and Out of network providers.
Training your staff on keeping current with timely filling changes will help you avoid unnecessary denials and ensure that claims are submitted on time and paid.
In this article, as you see by the title of it, we will look at the timely filling requirements change for AETNA Out of network providers.
As per Aetna, for all claims submitted on or after DOS 01/01/2022 the new timely filling will be 12 months. Down from 27 months.
Aetna is doing this to match Centers for Medicare & Medicaid Services (CMS) standards. The change will apply to medical procedures.
Dental Out of network providers will continue to have 27 months timely filling frame for their claims.
According to Aetna the denials will start showing up in 2023 and all policy exceptions to timely filing today will apply after this change and will be supported as they are today.
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KR2 Medical Billing 