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Regulatory Updates
Regulatory Updates
Regulatory Updates
CVS HEALTH COMPLETES
ACQUISITION OF AETNA

CVS Health is the nation’s premier health innovation company helping people on their path to better health. Whether in one of its pharmacies or through its health services and plans, CVS Health is pioneering a bold new approach to total health by making quality care more affordable, accessible, simple and seamless.

The combined company will connect consumers with the powerful health resources of CVS Health in communities across the country and Aetna’s network of providers to help remove barriers to high quality care and build lasting relationships with consumers, making it easier for consumers to access the information, resources and services they need to achieve their best health. CVS is developing several community-based programs and medical cost reduction programs.

The Aetna brand name will continue to be used in reference to the health insurance products. Going forward, Aetna will operate as a standalone business within the CVS Health enterprise and will be led by members of its current management team.

Source: aetna.com
AETNA NEW PREAPPROVAL RULES FOR NY AND NJ PROVIDERS

Effective January 1st, 2019 National Imaging Associates, Inc. (NIA) will authorize certain services for New Jersey and Western New York on behalf of Aetna. 

The NIA program doesn’t apply to therapy performed in certain places, including: 

  • An inpatient setting, including skilled nursing facilities.
  • A home setting.
  • An urgent or emergent care setting. 

To get an online authorization login web site

For general information, call provider services center at:

1-800-624-0756 for HMO and Medicare Advantage plans

1-888-632-3862 for PPO plans

Source: aetna.com
AETNA POLICY UPDATES

Effective March 1, 2019 Aetna will implement following policy changes:

  1. Aetna will no longer allow payment for physiologic studies of upper or lower extremities (CPT codes 93922, 93923 and 93924) when performed on the same day as a duplex scan (CPT codes 93925, 93926, 93880 and 93882). Physiologic studies services and duplex scans considered to be mutually exclusive.
  2. Aetna will deny CPT codes 29105 – 29131 and 29505 – 29515, application of casts or splints, when billed for the same date of service as HCPCS codes for prefabricated collars, orthosis and splints.
  3. 3. Aetna will be updating policy on definitive drug testing to allow testing of up to eight definitive drug classes per date of service. Still eight definitive drug test encounters will be allowed per rolling 12-month period across all providers. Drug testing procedure codes received for an allowable encounter of more than eight definitive drug classes per day will be considered at the rate for G0481 and reimbursed accordingly.
Regulatory Updates

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Insights
December 2018