how does ncqa accreditation help aetna how does ncqa accreditation help aetna

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. Aetna is committed to Accreditation by the National Committee for Quality Assurance (NCQA) as a means of demonstrating a commitment to continuous quality improvement and meeting customer expectations. The Benefit ofWorking with Certified Vendors to Achieve Health Plan Accreditation, As described above, seeking accreditation is anarduous process. xbbbd`b``l $ u Out of 26 MCPs in the state, 12 plans currently have NCQA accreditation, and four are pending an accreditation visit. More people are using telemedicine. NCQA Health Plan Accreditation is a widely recognized, evidence-based program dedicated to quality improvement and measurement. In case of a conflict between your plan documents and this information, the plan documents will govern. Members also told us the assistance they received helped them better manage their health, We surveyed members in the Aetna Disease Management program. Applicable FARS/DFARS apply. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Our quality improvement program helps improve the behavioral health care we provide to you. 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. We also work closely with numerous national health care organizations that have identified racial and ethnic disparities in health care as an issue that needs attention and action. Please be sure to add a 1 before your mobile number, ex: 19876543210, follow-up care for children prescribed ADHD medication (ADD), screen for co-existing mental health and substance use disorders, Measure, monitor and improve clinical care and quality of service, Launch company-wide initiatives to improve the safety of our members and communities, Make sure we obey all the rules, whether they come from plan sponsors, federal and state regulators, or accrediting groups, Developing policies and procedures that meet clinical practice standards, Reviewing preventive and behavioral health services and how care is coordinated, Addressing racial and ethnic disparitiesin health care that could negatively impact quality health care, Monitoring the effectiveness of our programs, Studying the accessibility and availability of ournetwork providers, Monitoring the overuse and underuse of services for our Medicare members, Performing credentialing and recredentialing activities, Assessing member and provider satisfaction. This information is neither an offer of coverage nor medical advice. How do I get NCQA certified? 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. Aetna Student Health is the brand name for products and services provided by Aetna Life Insurance Company and its applicable affiliated companies (Aetna). 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. Build vs. Buy: Which Health Risk Assessment Approach is Right for You. 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). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Through the accreditation process, organizationsare able toperform a gap analysis and identify areas for improving their evidence-based practices. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. NCQA conducts the survey and determines your accreditation status within 30 days of the final review. 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. Update educational materials and articles on the provider website to ensure that information is accurate. 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. All Rights Reserved. Data leads to insight about member health needs, which strengthens our ability to develop targeted initiatives. CPT only copyright 2015 American Medical Association. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Develop robotics expertise and automated solutions for manual work and data entry. The typical evaluation time frame is 12 months from application submission to decision, depending on an organizations readiness. The standards focus on: Quality Management and Improvement Population Health Management Network Management Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Download our case study to learn how vendors earn NCQA certification, and the value this recognition has brought toWellsourceclients for over a decade running. What is a health risk assessment and how do they work? Create and deliver quality improvement, management or assessment programs and processes. Terms of Use, Patient-Centered Specialty Practice (PCSP), Credentials Verification Organization (CVO), Managed Behavioral Healthcare Organization (MBHO), Health Information Technology Prevalidation Programs, Virtual Seminars, Webinars and On-demand Training, Advertising and Marketing Your NCQA Status. In case of a conflict between your plan documents and this information, the plan documents will govern. NCQA's Health Equity Accreditation Plus helps health care organizations that have implemented core Health Equity Accreditation activities establish processes and cross-sector partnerships that identify and address social risk factors in their communities and the social needs of the people they serve. hbspt.cta._relativeUrls=true;hbspt.cta.load(3949674, '00e7b261-db89-4360-9393-9d0dda543729', {"useNewLoader":"true","region":"na1"}); Tags: 0000001781 00000 n The standards align with many state requirements. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Certain races and ethnicities encounter certain diseases and conditions at higher rates. Interested in other accreditation options? Ratings emphasize care outcomes (the results of care) and what patients say about their care. 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. 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. This Agreement will terminate upon notice if you violate its terms. Download, NCQA NCQA accreditation or interim accreditation, while an additional six MCPs are in the process of achieving accreditation; that is 18 of 24 currently contracted MCPs. Disclaimer of Warranties and Liabilities. NCQA Credentialing Accreditation is a comprehensive program that evaluates the operations of organizations providing full-scope credentialing services, which include verifying practitioner credentials, designated credentialing-committee review of practitioners and monitoring practitioner sanctions. ,) V-Wz/"HESru66x k#1:1eM8Q g`$d(d|jJ\]7CY]h:tUf5u{;=== fJ*F=(W3OiLz}mLT EN"TPrr5[U1 UEpQ_(!`9%1pcrYfgNrLB,e~'usgg=E@gIU wFGfMK_* T@F2w\0t~Xx[J4pKqa}o* ]xqx03P^=NcjdU1al7%D2y'AL,,UB,b6 Thankfully, NCQA has streamlined part of the process through its vendor certification program, in which vendors can be vetted for quality by NCQA, see the full directory of approved vendors and accredited organizations here. trailer /Size 49 /Info 8 0 R /Root 10 0 R /Prev 21523 /ID[060e888545013965100abd54e3afe5c1>060e888545013965100abd54e3afe5c1>] >> startxref 0 %%EOF 10 0 obj /Type . NCQA health plan accreditation is awidely-recognized, evidence-based program that works to ensure quality improvement and measurementthroughaligning organizations witha comprehensive framework. As one of the nations leading health plans, Aetnas members represent the countrys increasing diversity in race, ethnicity and language. Health (9 days ago) WebNCQA's Health Plan Ratings 2022 include commercial, Medicare, and Medicaid health plans. If you do not intend to leave our site, close this message. As a result, many MCPs already follow NCQA guidelines with regard to care coordination or population health management. Thankfully, NCQA has streamlined part of the process through its vendor certification program, in which vendors can be vetted for quality by NCQAsee the full directory of approved vendors and accredited organizations here. Aetna Better health has implemented the following Credentialing process to meet NCQA Standards: NCQA is implementing the exceptions noted above for the March 1 -September 1, 2020, time frame. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Interested in other accreditation options?Click hereto learn more about how Wellsource products help organizations prove to accrediting bodies that their programs can measure health risks, segment and stratify populations, target interventions, and provide health education and self-management tools. CPT only copyright 2015 American Medical Association. Maintain Your License. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). NCQA Confers Health Equity Accreditation on Elevance Health Medicaid Plans Aetna Medicaid Plan Recognized by NCQA for Health Equity Efforts UnitedHealthcare Grants Address Social Determinants of . Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. You will be prompted to log in to your NCQA account. I am a results-driven Health Services professional with over 15 years of experience in Collecting, Organizing, Interpreting, Disseminating various types of data, Project/Program Management . Some organizations may already be working within NCQA guidelines. 0000001192 00000 n This certification signals our commitment to providing a best-in-class solution based on industry best practices and evidence-based research that will support health and improve outcomes. If you are currently accredited and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA. The standards provide a framework for adopting industry best practices to accurately and efficiently credential and recredential health care professionalsensuring that medical organizations employ qualified professionals and align with state requirements. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Use the report cards to find health plans, practices, clinicians or other partners that meet NCQA standards and can help you drive improvement, keep people healthy and reduce health care costs. URL: www.aetna.com. Weve partnered with Psych Hub to offer a customized suicide prevention training and certification program to all contracted network behavioral health and EAP providers at no cost. Please note that NCQA does not endorse MCG Health's solutions, or require the use of MCG care guidelines to achieve accreditation.