Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Members should show their DSNPmember ID cardand their state-issued Medicaid card. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). If you do not intend to leave our site, close this message. All rights reserved. ", Provider/facility name OR specialty is required to continue. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Learn about your health plan or find coverage for you and your family. Provider/Facility Name OR Specialty is required to continue, Please enter first and last name of Provider, or the name of the facility. Links to various Aetna Better Health and non-Aetna Better Health sites are provided for your convenience. Check your participation status using the provider search tool. You can narrow your Aetna provider search by filtering provider characteristics, geographic location and best matched . License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Choose the type of plan you're interested in to search for health care providers that accept it. What's covered? Members must select a primary care physician. 2. All Rights Reserved. Please check before scheduling an appointment to make sure the provider is participating in the program. You can further filter the search results by adding a specific dentists name and/or the type of dental specialist you wish to see. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Copyright document.write(new Date().getFullYear()) Aetna Better Health of Illinois, All Right Reserved. Links to various non-Aetna sites are provided for your convenience only. Want to help transform health care? 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. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Note not all Aetna dental plans and offers available in all markets. Oncology treatment plans must be submitted to NantHealth via their web portal, Eviti Connect, which will expedite clinical review of any chemotherapy, radiation therapy, or supportive medications that require prior-authorization. Some subtypes have five tiers of coverage. Primary Care Providers, specialists, mental health providers, Qualified Family Planning Providers (QFFPs), dentists and vision care providers. If you do not intend to leave our site, close this message. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. ALL inpatient confinements require PA and usually ALL services provided by non-participating providers require PA. PA requirement results are valid as of todays date only. Adult day services, assisted living, home-delivered meals, home health agencies and home medical equipment providers. You will receive the discount off the providers usual and customary fees when you pay. Find a Dentist. Or they can help you find a provider. Search result definitions: NOTE: When selecting by CPT group, the results displayed include CPT codes where Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. *Search by : Provider ID (PIN) NPI. Please correct the following errors and try again: Fill out this form to find providers and health care facilities near you. Reprinted with permission. When billing, you must use the most appropriate code as of the effective date of the submission. No fee schedules, basic unit, relative values or related listings are included in CPT. Listing Websites about Aetna Better Health Dental Provider. 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. Applicable FARS/DFARS apply. Please log in to your secure account to get what you need. Pharmacy, dental or vision providers? The member's benefit plan determines coverage. Of course you can use our directories to find doctors and hospitals that take your insurance. To help us direct your question or comment to the correct area, please select a category below. Find your plan listed below and click Find a Dentist. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". 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. Members must choose a PCP* to guide their treatment and coordinate all specialist care which all takes place in a quality network to keep costs in check. The five character codes included in the Aetna Medicaid PA Requirement Search Tool are obtained from Current Procedural Terminology (CPT), by the American Medical Association (AMA).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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. Search results are not a guarantee of claim payment. Tools and resources that create a more personalized and convenient . Did you find information that you think may need to be updated in our provider directories? Unrivaled access to care in 200+ countries and territories around the world. Select a Plan * Select a Plan: 2. 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. This information is neither an offer of coverage nor medical advice. logo Aethna Better Health of West Virginia. To see if your doctor is in our network, click a plan link below. Others have four tiers, three tiers or two tiers. 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. Please review the plan benefit coverage documentation under the link below. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Aetna Better Health is not responsible or liable for non-Aetna Better Health content accuracy or privacy practices of linked sites or for products or services described on these . Street Address: City: State: County: Zip Code: Radius: . The member's benefit plan determines coverage. Each plan has its own provider network. Aetna Better Health of Illinois is not responsible or liable for non-Aetna Better Health content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. 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. You are now being directed to the CVS Health site. Innovative benefits plans with options for medical, dental, vision, and pharmacy coverage. You are now being directed to the CVS Health site. Aetna has one of the nation's largest dental networks, with more than 200,000 participating dental practices, making it easy to find a great dentist or specialist near you. You are now being directed to CVS caremark site. Prosthodontists: restore damaged teeth or replace missing ones, with procedures that include dental implants, bridges, crowns and dentures. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. ALL inpatient confinements require PA and usually ALL services provided . The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Disclaimer of Warranties and Liabilities. Your plan may only provide benefits if you obtain a referral from your General Dentist prior to receiving treatment from a Specialist. Each main plan type has more than one subtype. Links to various non-Aetna sites are provided for your convenience only. Category: Health Detail Health. Family planning, Emergent and Urgent Care services do not require PA. 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. If you are in New Jersey, check your status by going to the Aetna Assure Premier Plus provider search page. 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. Click here to let us know so we can fix it. Since Clinical Policy Bulletins (CPBs) 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Used with express permission. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. Each main plan type has more than one subtype. Need a new dental office home? 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. You'll find these doctors with the label "Quality Care," "Effective Care" or both in your search. Important information for Provider Search users who live in California , Colorado , Connecticut , Delaware , Florida . You also can look for more than 25 other types of health care providers, including pharmacies, marriage counselors, urgent care centers, acupuncturists, drug and alcohol counselors, hospice care providers, dialysis centers, vision care providers, flu shot providers and physical therapists. CPT is a registered trademark of the American Medical Association. Links to various non-Aetna sites are provided for your convenience only. The member's benefit plan determines coverage. The online provider directory is updateddaily. The 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) for a particular member. Enter Location Avsis provides vision and dental claim and administrative services by agreement with Aetna Inc. Health benefits and health insurance plans contain exclusions and limitations. Due to the impact of the COVID-19 pandemic, many provider offices may need to adjust their office hours or redirect patients to others offices. System (HCPCS) codes or a CPT group and select SEARCH. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Enter your location by address, city or zip code. Links to various non-Aetna sites are provided for your convenience only. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. CPT only Copyright 2022 American Medical Association. Skip to main content . Please refer to your Summary Plan Description (SPD) for an outline of your plan's covered benefits . While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. 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). You also can look for more than 25 other types of health care providers, including pharmacies, marriage counselors, urgent care centers, acupuncturists, drug and alcohol counselors, hospice care providers, dialysis centers, vision care providers, flu . 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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. Please confirm with the provider when you call them. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. The ABA Medical Necessity Guidedoes not constitute medical advice. By clicking on I accept, I acknowledge and accept that: Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Click here to find an in-network pharmacy provider thats close to you. Links to various non-Aetna sites are provided for your convenience only. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). The path to healthy starts here. 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). As a LIBERTY enrollee (including enrollees with disabilities), you have full and equal access to covered services as required under the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. If your patient has primary Medicare coverage outside of Aetna Better Health Premier Plan, please call the Medicare plan for benefits and authorization requirements. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. and you keep saving there is no maximum annual spending limit! Health (8 days ago) AdHighly-reviewed Dentists who take your insurance and are ready to see you. *Required Selections. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Aetna Dentists Near Me. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. Treating providers are solely responsible for dental advice and treatment of members. Looking for a local dentist? Links to various non-Aetna sites are provided for your convenience only. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Members should always contact the provider's office in advance to confirm availability. Thanks! 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. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. AetnaDentalOffers.com is brought to you by DentalPlans.com. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Youd likely go to an oral surgeon if you have an impacted wisdom tooth or need another type of other complicated extraction. We update our provider directory nightly.You can get a copy of the provider directory by mail.

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