What is a policy bulletin?

Using Clinical Policy Bulletins to determine medical coverage. Medical Clinical Policy Bulletins (CPBs) detail the services and procedures we consider medically necessary, cosmetic, or experimental and unproven. They help us decide what we will and will not cover.

Does Aetna cover 99358?

Prolonged physician services 9/1/2011 Aetna does not pay for medical services without direct patient contact; thus, procedure codes 99358 and 99359 will be denied.

What is a clinical policy?

Clinical policies — also known as clinical guidelines, clinical practice guidelines, practice parameters and practice policies — are sets of recommendations for the care of patients with specific conditions or diseases.

Does Aetna follow CMS guidelines?

Aetna is complying with the CMS coding guidelines for COVID-19 lab testing.

Does Aetna pay for consults?

But United Healthcare has a new payment policy that allows payment for consultations. Other payers, including Cigna, Aetna, and Anthem, do cover consultations in most states.

Does Aetna cover moderate sedation?

What is true is that we have always covered moderate sedation for routine colonoscopies and endoscopies, and our new policy will continue to cover moderate sedation.

Why is it important to update policies and procedures in healthcare?

Importance of policies and procedures in healthcare Policies and procedures set expectations and proper ways of doing things. They guide day-to-day activities, helping promote consistency in practices, reduce mistakes, and keep patients and staff safe.

How do you evaluate and implement clinical policies?

Evaluating a clinical policy

1. Assemble a team and build consensus.
2. Document your clinical processes.
3. Modify the policy for local use.
4. Communicate changes in processes.
5. Decide how to evaluate the policy.
6. Test the changes or interventions.
7. Adopt the revised clinical policy.
8. Evaluate the new policy.

Does Aetna accept consult codes 2020?

How long does Aetna take to process a claim?

If we had to approve your claim before you got care, we will decide within 30 days of getting your appeal. For other claims, we’ll decide within 60 days.

Does Aetna cover consult codes 2020?

Does Aetna allow for incident to billing?

Aetna credentials both APRNs and PAs and follows Medicare rules for incident-to and shared services.

What do clinical policy bulletins do for Aetna?

Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider.

What are clinical policy bulletins ( CPBs ) and why are they important?

Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members.

Who are Aetna specialty institutes and aexcel performance network?

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Is there a link to the Aetna website?

Health benefits and health insurance plans contain exclusions and limitations. Links to various non-Aetna sites are provided for your convenience only. 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.