Tag: Aetna
Aetna OfficeLink Updates 6/1/2021
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Updated Plan Reps
The Health Plan Representative Contact List has been updated.
News from Aetna
Check out the news from Aetna regarding: (click)
- Changes to their National Precertification
List (NPL) - Submitting precertification requests
- How to use Availity to request precertification online
News from Aetna, April 15, 2021
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Prior Auth. Time Frames
Several commercial payers have resumed prior authorization time frames and requirements that had been suspended because of the COVID-19 emergency, while others will continue to approve prior auth requests or suspend them for at least part of the year.
Below is an overview of some payers’ COVID-19 prior authorization policies as of April 2021: Click on the Links for more detail.
Blue Cross and Blue Shield of Texas ended approvals on services with existing prior authorizations on Dec. 31, 2020.
Aetna is approving prior authorization requests for commercial and Medicare Advantage members until the end of the plan year. “Authorization may be extended beyond the plan year, for a period of six months, if continued eligibility can be confirmed.”
Cigna resumed standard prior authorization time frames and requirements beginning April 1, 2021.
Humana resumed standard prior authorization time frames and requirements beginning April 1, 2021
UnitedHealthcare will not require prior authorization for most services through the national public health emergency period, currently scheduled to end April 20, 2021. Exceptions include medical and behavioral health services, post-acute care admissions, site of service reviews, and transfers to new providers. Prior authorizations for medical and behavioral health were not subject to extension on or after April 10, 2020.
Article written by Ellen Terry : https://www.texmed.org/TexasMedicineDetail.aspx?id=53502&utm_source=Informz&utm_medium=Email&utm_campaign=TMT&_zs=cPrdA1&_zl=CvCF6
Aetna Commercial Drug Changes
Changes to Aetna's Commercial Drug Lists
On July 1, 2021, Aetna will update their pharmacy drug lists.
You’ll be able to view the changes as early as May 1, 2021. They’ll be available on our Formularies & Pharmacy Clinical Policy Bulletins page.
Ways to request a drug prior authorization
- Submit your completed request form through our provider portal on Availity
- For requests for nonspecialty drugs on Aetna Funding Advant age5M , Premier, Premier Plus, Small Group ACA and Value Plus plans, call the Precertification Unit at 1-855-240-0535 (TTY: 711). Or fax your completed prior authorization request form to 1-877-269-9916.
- For requests for nonspecialty drugs on the Advanced Control, Advanced Control – Aetna, Standard Opt Out, Standard Opt Out – Aetna, Standard Opt Out with ACSF, Aetna Health Exchange and High Value formulary plans, call the Precertification Unit at 1-800-294-5979 (TTY: 711). Or fax your completed prior authorization request form to 1-888-836-0730.
- For requests for drugs on the Aetna Specialty Drug List, call the Precertification Unit at 1-866-814- 5506 (TTY: 711). Or fax your completed prior authorization request form to 1-866-249-6155.
These changes will affect all drug lists, precertification, quantity limits and step-therapy programs. For more information, call the Provider Help Line at 1-800-238-6279 (TTY: 711) (1-800-AETNA RX).
Aetna Authorization Changes
Changes to Aetna National Precertification List (NPL)
As published in the March 1, 2021, edition of Aetna Officelink Updates™
As of July 1, 2021, these precertification changes apply:
- We’ll require precertification for:
- Cataract surgery
- Sacroiliac joint fusion surgery
- Knee arthroscopy with meniscectomy
- Vertebral corpectomy procedures
- Additional lower limb prosthetic codes including select foot, ankle and vacuum pump components
- Spinraza® (nusinersen) – precertification required for both the drug and site of care.
Submitting requests
Be sure to submit authorization requests at least two weeks in advance.
To save time, you can make your request online. Doing so is fast, secure and simple. You can submit most requests online through our provider portal on Availity. Or you can use the Electronic Medical Record (EMR) system portal.
Are you asking for drug prior authorization on a specialty drug for a commercial or Medicare member? Then submit your request through Novologix®, also available on Availity®.
Not registered for Availity?
Register online or call 1-800-AVAILITY (1-800-282-4548). For one-on-one support from us, call Aetna at 1-866-752-7021. Then ask to talk with the Availity team.
You can use our “Search by CPT code” search function on our Precertification Lists web page to find out if the code needs precertification.
You can learn more about precertification under the General Information section of the NPL.
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