Caring for our customers Fall 2017 Updates

Websites Websites for health care professionals www.aetna.com Information on how to work with us, products & programs, resources for health care professionals and helpful links. www.navinet.net Information on member eligibility, claim status, EOBs, claim reconsiderations, secure emails to provider services, claim payment policies, claims reimbursement tool, claims payment estimator and much more!

Aetna OfficeLink Updates – News you can use Aetna OfficeLink Updates delivers timely information for your practice or facility. The online newsletter is published in March, June, September and December. Inside each issue providers will find: Updates to our precertification list Clinical payment, coding and policy updates Medicare information Pharmacy information Plan and product information State specific news Providers may also chose to sign up to receive the electronic communication via email located in the OfficeLink section of Aetna’s website. Newsletters can be found by going to www.aetna.com, Health Care Professionals, Newsletters & News, Read OfficeLink newsletters and then Mid-America OfficeLink Update newsletter. All previous copies are stored online as a reference.

Aetna at a Glance A quick reference guide for health care professionals The quick reference is a great tool to find: Secure website (NaviNet) resources & information Secure website (NaviNet) tools and transactions Claims submission information & claims addresses Provider Service Center contact information Contact information specific to the Mid-America Region This guide can be found by going to www.aetna.com, Health Care Professionals, Education & Manuals, Explore provider manuals, Read our quick-reference guide.

Provider Manuals Provider manuals about our policies and programs You can view and download these manuals: Office Manual for Health Care Professionals Behavioral Health Provider Manual Women’s Health Programs and Policies Manual Aetna Benefits Product Guide Provider manuals can be found by going to www.aetna.com, Health Care Professionals, Education & Manuals, Explore provider manuals Coventry Health Care provider office manuals are located on www.chcnebraska.com, Services & Support, Providers, Document Library, Provider Manual

Educational webinars Learn how to work with us electronically We offer interactive, 45-minute webinars that walk you through how to use our online tools. How to register for webinars Register online at www.aetna.com, Health Care Professionals, Provider Education & Manuals, Educational Webinars and click the Complete the online webinar registration form link. Sent an email to eSolutionsTraining@aetna.com with the name and date of the webinar in the subject line.

Claims, Payment & Reimbursement Convenient tools and guidelines to help you get paid faster ERA, EFT and Electronic EOB information Coordination of benefits & claims submission information Electronic transaction tools Payment estimator & fee schedule information Aetna Signature Administrators (ASA) information Overpayment information This information can be found by going to www.aetna.com, Health Care Professionals, Claims, Payment & Reimbursement

Disputes & Appeals Process Our process for disputes and appeals Log onto www.aetna.com, Health Care Professionals, Disputes & Appeals to learn more about Aetna’s Dispute & Appeals process Reconsiderations and Disputes can be submitted online through NaviNet. The denial determines whether the review requested is a dispute/reconsideration or an appeal. All appeals require the Practitioner and Provider Complaint and Appeal form or the Member Complaint and Appeal form. Please see the FAQs for additional information on what is considered an appeal vs reconsideration. Mailing address for reconsiderations: Aetna Provider Resolution Team PO Box 981106 El Paso, TX 79998-1106

Precertification Precertification occurs before inpatient admissions and select ambulatory procedures and services. Check the precertification lists by going to www.aetna.com, Health Care Professionals, Precertification, Check our precertification lists New updates were made 9/1/17 Search by an individual CPT code You can submit a precertification request through our secure provider website (NaviNet) or by phone using the number on the member’s ID card

Clinical Policy Bulletins Clinical Policy Bulletins (CPBs) are used to determine medical coverage CPBs detail the services and procedures we consider medically necessary, cosmetic, or experimental and unproven. Search our CPBs using CPT Codes Key words CPB number These bulletins can be found by going to www.aetna.com, Health Care Professionals, Clinical Policy Bulletins. Then you can select Medical Clinical Policy Bulletin www.navinet.net, claims, code editing, clinical & payment policy look up. There is a look up tool that will show you which CPB is linked to a denial on your claim.

Management and Network Services LLC (MNS) Effective January 1, 2018, MNS won’t be a contracted provider. MNS will no longer coordinate the skilled nursing services for credentialing or manage authorizations or claims payment. This change impacts all patients enrolled in Aetna and/or Coventry Medicare, Commercial or network access business (First Health, auto or workers’ compensation) lines of business. For dates of service on or after 1/1/18, please submit all patient claims directly to Aetna and/or Coventry. Check the back of the member’s ID card for the correct address or claim-payer ID number. Aetna is currently in the process of contracting directly with all of the skilled nursing facilities. Effective 1/1/18 Providers will work directly with Aetna for precertification.

Keep your information up to date To update your office’s demographic information, go to NaviNet and sign in. You should notify us whenever you have: New email or mailing addresses New phone or fax numbers Name changes due to marrige or another life event A new policy regarding accepting new patients A new hospital or group affiliation Make sure your CAQH is up to date and accurate Aetna uses CAQH data to match up and compare to demographic information in our provider systems Mismatches fall out onto a report for research If you use CAQH for your credentialing, please make sure that only addresses you are practicing at are listed

Aetna plans offered What plans will be available in 2018? Aetna Plans will include Commercial HMO, PPO, POS, Open Access plans Performance network commercial plans offered with the CHI Health ACO, Nebraska Health Network high performance network and MIPPA high performance network Aetna’s CHI Health ACO product is currently sold in Douglas, Sarpy and Pottawattamie counties 2018 additional counties will include: Buffalo, Dawson, Hall, Howard, Lancaster, Phelps and Saline Medicare plans (Aetna Medicare in Nebraska is only offered as a retiree program for employers at this time) Aetna Signature Administrators (ASA) contracts directly with TPA’s to access Aetna’s PPO network For additional information on ASA, please visit www.aetna.com Meritain Health is an Aetna Company that offers the use of Aetna’s national networks

Coventry plans offered What plans will be available in 2018? Coventry Plans will include Commercial HMO, PPO, POS, Open Access plans Performance network commercial plans offered with the CHI Health, Nebraska Health Network and MIPPA high performance networks ** No new employer groups will be offered these plans for 2018. These plans will only be offered to employers currently on them in 2017 through the KWYH legislation. Medicare plans – Coventry Medicare Advantage Plans will remain Coventry until at least 2020 Medicare Advantage HMO & PPO Coventry Total Care – High performance Medicare network that only includes CHI providers. This product is only sold in Douglas, Sarpy and Pottawattamie counties. First Health is the rental network for TPA clients to access as payers. For a current listing of First Health clients, please log into www.directprovider.com ** Due to the KWYH (keep what you have) legislation, Coventry is required to offer employer groups currently on a Coventry plan that same plan for 2018. Unless other legislation requires Coventry to change something, all Coventry groups except for Medicare will be offered an Aetna plan for 1/1/19.

Aetna Leap Aetna Leap is Aetna’s individual member plans Aetna Leap plans will not be offered on or off the exchange for 2018 Aetna Leap began 1/1/17 and members will be honored who have paid premiums through 12/31/17 Aetna Leap members only have digital ID cards unless the member has requested a plastic copy be mailed to them Aetna Leap member eligibility and claims processing are housed on a different claims platform than traditional Aetna Aetna Leap eligibility checks, claims status, reconsiderations and other electronic tools are available through NaviNet

Aetna Leap Issues & Corrections Aetna Leap Identified Issues Not all Provider contract information transferred over to the Aetna Leap systems Providers were not showing all of the correct networks as participating Providers may still be told they are out of network by Customer Service, we continue to do education when necessary. If you are told you are out of network and you believe this is not correct, please ask to speak to a supervisor. Please make sure to provide a reference number, name of representative and member information. This assists us with all education and tracking. Aetna Leap Corrections We continue to update systems when errors are found or identified We continue to monitor open projects waiting for reprocessing by meeting weekly with the Leap projects team on status updates Projects are very back logged but we continue to ask for weekly updates to track progress

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