Full Answer
What is a fee schedule for insurance?
A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis.
Does Aetna cover consult codes 2022?
Starting March 1, 2022, we will no longer pay office consultation codes 99241, 99242, 99243, 99244 and 99245.
Does Aetna Medicare follow CMS guidelines?
Aetna Medicare Dual Core (HMO SNP) plans All MA plans are required to offer Medicare Parts A and B medical benefits and to follow CMS' national and local coverage decisions.
How do I get my Aetna EOB?
You can view, print or download your EOB and other documents anytime at www.aetna.com. Want to stop the paper? It's easy. Log in to your secure member website at www.aetna.com, go to “Your Profile,” provide a valid email address and select your paper-saving preferences.
Which codes are used for outpatient?
The three main coding systems used in the outpatient facility setting are ICD-10-CM, CPT®, and HCPCS Level II. These are often referred to as code sets.
Does Aetna use modifiers?
Modifiers may be appended to HCPSC/CPT codes only if the clinical circumstances justify the use of the modifier. A modifier shall not be appended to a HCPCS/CPT solely to bypass an NCCI PTP edit if the clinical circumstances do not justify its use (NCCI Policy Manual, January 2021, pg.
What is the most popular Medicare Advantage plan?
AARP/UnitedHealthcare is the most popular Medicare Advantage provider with 27% of all enrollment. Plans are well rated and have affordable premiums and add-on benefits, a valuable combination that could account for the company's popularity.
Is Aetna Medicare Advantage the same as Medicare?
Both terms refer to the same thing. Instead of Original Medicare from the federal government, you can choose a Medicare Advantage plan (Part C) offered by a private insurance company. These plans include all of the benefits and services of Parts A and B. They may include prescription drug coverage as part of the plan.
Does Aetna Medicare require authorization?
For some services, your PCP is required to obtain prior authorization from Aetna Medicare. You'll need to get a referral from your PCP for covered, non‐emergency specialty or hospital care, except in an emergency and for certain direct‐access service. There are exceptions for certain direct access services.
How do you find EOB availity?
Register for our Availity provider portal. * Get identical copies of your EOB statements from the Availity Remittance Viewer. Then print or save them to your computer. You won't need to wait for them to arrive in the mail.
What EOB means?
Explanation of BenefitsPage 1. 16COL3454. EOB stands for Explanation of Benefits. This is a document we send you to let you know a claim has been processed. The most important thing for you to remember is an EOB is NOT a bill.
Can I view my Medicare EOB online?
Your explanation of benefits, also called an EOB, is an important tool to help you keep track of your plan usage. Every time you get a new Medicare medical or Part D prescription coverage explanation of benefits, you can save time and paper by signing up to view them online.
Does Aetna take consult codes?
Starting March 1, 2022, we will no longer pay office consultation codes 99241, 99242, 99243, 99244 and 99245.
Does Cigna accept consult codes?
Cigna does not reimburse for: For outpatient or inpatient consult codes.
Does Aetna cover CPT 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 the CPT code for hospital consultation?
Consultations for Medicare patients are reported with new patient (99201–99205) or established patient (99212–99215) Current Procedural Terminology (CPT) codes. For non-Medicare patients (unless otherwise instructed by a payor), office or other outpatient consultations are reported with codes 99241– 99245.
What is prior authorization in ABHFL?
Prior Authorization is needed for requests greater than limits indicated on Fee Schedule.
How long does it take to pay a DME claim?
Within fifteen (15) days, pay the electronic DME clean claim or notify the provider or designee that the claim is denied or contested. The notification to the provider of a contested claim must include an itemized list of denial reasons or codes and additional information or documents necessary to process the claim.
How to claim DME?
Providers submitting claims for Durable Medical Equipment (DME) Rental should use CMS 1500 Form. DME rental claims are only paid up to the purchase price of the durable medical equipment. Units billed for Medicaid equal the amount of days billed. Since appropriate billing for CMS is 1 Unit per month, in order to determine the amount of days needed to determine appropriate benefits payable under Medicaid, the claim requires the date span (from and to date) of the rental. Medicaid will calculate the amount of days needed for the claim based on the date span. Appropriate modifier, RR, is required for all rentals.
Does Aetna reimburse DME?
Aetna Better Health bases reimbursement of Durable Medical Equipment (DME) services on the Agency’s fee schedules. Any code that doesn’t have an assigned rate requires prior authorization and will be reimbursed at the manufacturer’s invoice plus 15%.
Do you need authorization for DME?
Standard limits do not apply, authorization is required for all DME services. Authorization is based on a member's individual needs as assessed on their care plan.
Who must sign a document and plan of care?
Documentation and Plan of Care must be signed by/dated by physician with specific term, duration & diagnosis
Does Aetna cover wheelchairs?
Aetna Better Health covers customized wheelchairs for children and adults as listed in the DME and Medical Supply Services Coverage and Limitations Handbook, pages 2-91 through 2-96, and the DME and Medical Supply Services Fee Schedule, including all accompanying parts needed to operate the equipment. Prior authorization is required.
