Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Unlisted, unspecified and nonspecific codes should be avoided. CPT only copyright 2015 American Medical Association. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. All provider information contained on this website is subject to change. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Adult day services, assisted living, home-delivered meals, home health agencies and home medical equipment providers. The HMO plan is ideal for employers in urban locations who want to offer simple, convenient care with fixed, predictable costs. Please enable it to continue. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Aetna Dental Savings Plans are NOT dental insurance and the dental savings will vary by provider, plan and zip code. Do you want to continue? No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. 2. If you have questions, visit our contact us page. Aetna Medicaid collaborates with providers to deliver care that meets cost and quality goals. It provides coverage for a wide range of dental services, including . Log in to find doctors, dentists, hospitals and other providers that accept your plan. Category: Health Detail Health. Unlisted, unspecified and nonspecific codes should be avoided. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Important information for Provider Search users who live in California , Colorado , Connecticut , Delaware , Florida . Visit the secure website, available through www.aetna.com, for more information. 2023 LIBERTY Dental Plan, All Rights Reserved. Click here for additional information regarding benefit coverage. 2022 Dual Eligible Special Needs Plans (DSNPs) information, Required Centers for Medicare & Medicaid Services (CMS) training, Please be sure to add a 1 before your mobile number, ex: 19876543210, Precertification lists and CPT code search, OfficeLink Updates Newsletters Medicare Updates, Aetna Better Health of Virginia provider search page, Aetna Assure Premier Plus provider search page. All rights reserved | Email: [emailprotected], North country health care university flagstaff. We welcome . Please check before scheduling an appointment to make sure the provider is participating in the program. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Besides treating dental conditions, she educates her young patients on the importance of proper dental health and dispenses practical advice on maintaining dental hygiene. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Idaho Members: If you contact several providers who have indicated they will see new patients and find you cannot get an appointment, you may call Customer Service at 1-800-936-0978. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Directory of Dentists Treating Members with Intellectual Disabilities Adult. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. HMO Plan*; Open Access Plan; QCHP/CDHP Plan; For step-by-step instructions, click on a plan below. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Please log in to your secure account to get what you need. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Health. Oral and maxillofacial surgeons: focus on treating problems related to the hard and soft tissues of the face, mouth, and jaws. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Visit the secure website, available through www.aetna.com, for more information. For non-participating health care professionals. Treating providers are solely responsible for medical advice and treatment of members. Aetna Inc. and its affiliated 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. Each plan has its own provider network. Prior Authorization may be required. When billing, you must use the most appropriate code as of the effective date of the submission. Links to various non-Aetna sites are provided for your convenience only. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Access2Care performs transportation management services on behalf of Aetna Better Health. If your patient has primary Medicare coverage outside of Aetna Better Health Premier Plan, please call the Medicare plan for benefits and authorization requirements. This list is updated nightly. For children and other Medicaid members, dental providers are available through MCNA. Or they can help you find a provider. Links to various non-Aetna sites are provided for your convenience only. You can also get the materials you need in a different language or format. Disclaimer of Warranties and Liabilities. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Choose from the largest directory of in-person & video visit providers in the nation. CMS requires providers to take the Model of Care training course (PDF). This search will use the five-tier subtype. This search will use the five-tier subtype. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). If you do not intend to leave our site, close this message. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). The provider network is subject to change. https://www.bing.com/aclk?ld=e8pp1GAj_I-V3BVCYY9CDy-DVUCUwNn4b_zBqwYEAyr-b5hM7-uljdETFqFUDVn1verRx1HD9OEM8mlH0-4MuIitnhUOrSe-AsgxSUMwda7uvhTkMRqFaU9WzQiCY7N9Y6uEORiZbZ_yLxe-Ad0825VJyGWU7_QhyLDFQc1zv459ATOOp7YUal1ilBxK3MVXkJOzx6Og&u=aHR0cHMlM2ElMmYlMmZib29rLnpvY2RvYy5jb20lMmZnZXQtc3RhcnRlZCUyZmRlbnRpc3RzJTNmdXRtX3NvdXJjZSUzZGJpbmclMjZ1dG1fbWVkaXVtJTNkY3BjX2dlbmVyaWMlMjZ1dG1fY2FtcGFpZ24lM2Q0MDEyMTU1NTIlMjZ1dG1fdGVybSUzZCUyNTJCYWV0bmElMjUyMCUyNTJCZGVudGlzdCUyNnV0bV9jb250ZW50JTNkMTIzMzY1MjI2MTQ5NDAyNCUyNm1zY2xraWQlM2RlZTJhMzY3ZTU4YjMxZjhjNTcyZjUyMmU0YzlkOTgzMQ&rlid=ee2a367e58b31f8c572f522e4c9d9831, Health (2 days ago) WebEvery member with an Aetna Assure Premier Plus (HMO D-SNP) plan gets access to this dental benefit, including members who qualify for: Fully Integrated Dual-Eligible Special Needs Plan (FI D-SNP) Our members , https://www.aetnabetterhealth.com/new-jersey-hmosnp/providers/dental-services.html, Health (8 days ago) WebDental Savings Plans reduce the cost of dental care by 10%-60%, at thousands of participating dentists and dental specialists nationwide. It is only a partial, general description of plan or program benefits and does not constitute a contract. CPT is a registered trademark of the American Medical Association. Copyright document.write(new Date().getFullYear()) Aetna Better Health of Illinois, All Right Reserved. Disclaimer of Warranties and Liabilities. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Tools and resources that create a more personalized and convenient . symbol is displayed for the code, place your cursor over the symbol to review additional Aetna Inc. and itsaffiliated 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. This information helps us provide information tailored to your Medicare eligibility, which is based on age. Links to various non-Aetna sites are provided for your convenience only. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. In case of a conflict between your plan documents and this information, the plan documents will govern. Please log in to your secure account to get what you need. Find the information and resources you need to meet your clients' needs. YES - Prior authorization request is required for this service. The term prior authorization (PA) means the utilization review process determines whether the requested service, procedure, prescription drug or medical device meets the companys clinical criteria for coverage. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Explore Medicaid benefits and added services. Neither Aetna Inc. nor its subsidiaries are Guardian affiliates. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Each main plan type has more than one subtype. Please contact Access2Care for benefit information by calling 1-866-252-5634 or visit www.Access2Care.net. Others have four tiers, three tiers or two tiers. Some subtypes have five tiers of coverage. Links to various non-Aetna sites are provided for your convenience only. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. These directories of Louisianas network providers includes: Enter provider or facility name or select a specialty. All DSNP plans are required to have an approved Model of Care. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. To see if your doctor is in our network, click a plan link below. 1367 Walter Reed Rd, 103, Fayetteville, NC 28304. Aetna Better Health of Maryland Dental Provider Search. A DSNP is a special type of Aetna Medicare Advantage Prescription Drug (MAPD) plan. Members should discuss any matters related to their coverage or condition with their treating provider. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. Applicable FARS/DFARS apply. Select a Plan * Select a Plan: 2. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Pharmacy prior auth phone number: 1-855-221-5656. Medicaid your for low-income and working humans or families, their . Hospitals, long-term care facilities and skilled nursing facilities for rehabilitation, mental health facilities, Federally Qualified Health Centers and Rural Health Centers. you can call Aetna Better Health of Louisiana Member Services at 1-855-242-0802, TTY 711, 24 hours a day, 7 days a week. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Dental Savings Plans reduce the cost of dental care by 10%-60%, at thousands of participating dentists and dental specialists nationwide. Links to various non-Aetna sites are provided for your convenience only. Please correct the following errors and try again: Fill out this form to find providers and health care facilities near you. Health benefits and health insurance plans contain exclusions and limitations. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Please be sure to add a 1 before your mobile number, ex: 19876543210. Join our network, and together, we'll give patients access to the highest quality, safest and most effective health care. In-network coverage only (except emergency . Members must reside in a county where Aetna Medicare offers a DSNP. Links to various non-Aetna sites are provided for your convenience only. All Rights Reserved. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. If you are in New Jersey, check your status by going to the Aetna Assure Premier Plus provider search page. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater.
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