Tag: National Precertification List (NPL)
Highlights for Aetna OfficeLink Updates
Claim and Code Review Program (CCRP) update
Starting December 1, you might see new claim edits
This update applies to both our commercial and Medicare members.
Beginning December 1, 2025, you may see new claim edits. These are part of our CCRP. These edits support our continuing effort to process claims accurately for our commercial, Medicare and Student Health members. You can view these edits on our provider portal on Availity.
For coding changes, go to Aetna Payer Spaces > Resources. In the search bar, search for “expanded claim edits.”
Except for Student Health, you’ll also have access to our code edit lookup tools. To find out if our new claim edits will apply to your claim, log in to Availity®. You’ll need to know your Aetna® provider ID number (PIN) to access our code edit lookup tools.
We may request medical records for certain claims, such as high-dollar claims, implant claims, anesthesia claims, and bundled services claims, to help confirm coding accuracy.
Changes to our National Precertification List (NPL)
These changes apply to our commercial and Medicare members, unless otherwise noted.
Effective January 1, 2026, we’ll require precertification for the following:
• Electrophysiological (EP) study (93654)
• Yondelis® (trabectedin, J9352)
• Docivyx™ (docetaxel, J9172) — Medicare members only
Check out the Original Publication, titles like:
- How to secure an authorization
- Urgent requests
- Changes to commercial drug lists begin on January 1
- And More
Aetna March OfficeLink Updates
Changes in Aetna’s Commercial Drug List Begin on July 1, 2024.
Per Aetna, Changes may affect all drug lists, precertification, step therapy and quantity limit programs. Physician offices can view the changes as early as May 1, 2024. The changes can be found on Aetna’s Formularies and Pharmacy Clinical Policy Bulletins page.
Changes in Aetna’s National Precertification List (NPL)
This applies to both Aetna Commercial and Medicare Members. (POET does not have an Aetna Medicare contract at this time.) Per Aetna this change will also be effective July 1, 2024. They will require precertification for:
- Osteotomy posterolateral approach, thoracic
- Osteotomy anterior approach
- Knee meniscectomy-requires precertification for the Medicare Advantage members only.
Per Aetna, Be sure to submit precertification requests at least two weeks in advance. To save time, request precertification on line.
Aetna OfficeLink Updates 6/1/2021
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2021/06/Aetna-OfficeLink-Updates-2021.06.01.pdf” download=”all” viewer=”google”]
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
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2021/04/News-from-Aetna-2021.04.15.pdf” download=”all” viewer=”google”]
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.
Aetna OfficeLink Updates, Published 12/1/2020
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/12/Aetna-OfficeLink-Updates-12012020.pdf” download=”all” viewer=”google”]
Aetna OfficeLink Updates, Published 9/1/2020
- Changes to the National Pre-Certification List
- Third Party Claim and Code Review Program
- And many interesting topics
Aetna OfficeLink Updates, Published 09/01/2020
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/09/Changes-to-National-Precertification-List-09012020.pdf” download=”all” viewer=”google”]
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