NCQA conducts the survey and determines your accreditation status within 30 days of the final review. CPT is a registered trademark of the American Medical Association. NCQA Accreditation standards are intended to help organizations achieve the highest level of performance possible, and create an environment of continuous improvement. Asthma drug management Did people, . The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Collaborate with Network to access telehealth use analytics and its impact on accessibility and availability. One way were improving health care quality is by measuring how well we and others are doing. Data leads to insight about member health needs, which strengthens our ability to develop targeted initiatives. NCQA Accreditation as of June 30, 2019. 0000004583 00000 n The NCQA bases its general accreditation fee on a formula of $39,750 plus 16 cents per member if the plan's membership is over 50,000. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. The accreditations come after Aetna Better Health of Michigan, Inc., participated in an eight-month NCQA sponsored pilot to develop its Health Equity Accreditation Plus evaluation program. If you are not currently accredited and want to learn more, contact NCQA. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Thankfully, NCQA has streamlined part of the process through its vendor certification program, in which vendors can be vetted for quality by NCQAsee the full directory of approved vendors and accredited organizations here. Notification to Authorities and Practitioner Appeal Rights. What is the Value of NCQA & NCQA Credentialing Accreditation? Program Evaluation Treatment Outcome Questionnaires Models, Organizational Health Care Surveys Pilot Projects Data Collection Prospective Studies Reproducibility of Results Electronic Health Records Retrospective Studies Cross-Sectional Studies Research Design Follow-Up Studies Ambulatory Care Interviews as Topic Feasibility . NCQA health plan accreditation is a widely-recognized, evidence-based program that works to ensure quality improvement and measurement through aligning organizations with a comprehensive framework. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Download, NCQA Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Pricing is based on multiple factors. The standards focus on: Quality Management and Improvement Population Health Management Network Management LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). HRA, Purchase and review the program resources, conduct a gap analysis and submit your online application. Is UPMC A Medicaid Plan? | Insurance Guide The AMA is a third party beneficiary to this Agreement. Copyright 2023 National Committee for Quality Assurance. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. What is NCQA its history and key objectives? The member's benefit plan determines coverage. Methodology Aetna has taken a leadership role in finding and implementing solutions to the problem of health care disparities and for 10 years has been a catalyst for change. trailer We also give you and your doctors information and tools that can help you make decisions. 0000017970 00000 n Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 0000004213 00000 n Star ratings were created to help beneficiaries assess their care needs against the quality of Medicare Advantage health plans care and service. health risk assessment, Frankie Alstin-Brooks, PhD - Human Resources Partner - LinkedIn In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Agreement and Collaboration With Clients. %%EOF NCQA's Health Plan Accreditation program builds on almost three decades of experience measuring the quality of health plans. Accreditation HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). OTHER NAMES FOR THIS HEALTH PLAN. This certification signals our commitment to providing a best-in-class solution based on industry best practices and evidence-based research that will support health and improve outcomes. Checklist, The Top 3 Benefits of Health Risk Assessments, 3 Healthcare Marketing Trends Taking Center Stage in 2023. What makes for an engaging health and wellness program? CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. The overall rating is the weighted average of a plan's HEDIS and CAHPS measure ratings, plus bonus points for plans with a current Accreditation Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. Condition-targeted health assessments for service line growth. If you dont see what youre looking for below, you can search NCQAs database of additional common questionsor ask a question through My NCQA. Update educational materials and articles on the provider website to ensure that information is accurate. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. At the very least, patients must be given tools that help them to speak more confidently and effectively with their health care providers so that they can take greater control of their health and well-being. Develop preventive health, early detection and disease management programs and processes. Terms of Use, Patient-Centered Specialty Practice (PCSP), Credentials Verification Organization (CVO), Managed Behavioral Healthcare Organization (MBHO), Health Information Technology Prevalidation Programs, Virtual Seminars, Webinars and On-demand Training, Advertising and Marketing Your NCQA Status. Quickly to Meet Program needs, Certification and Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. NCQA > Certification - National Committee for Quality Assurance More people are using telemedicine. NCQA health plan accreditation is awidely-recognized, evidence-based program that works to ensure quality improvement and measurementthroughaligning organizations witha comprehensive framework. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". If you have questions about a Med Premier major medical plan, call The Boon Group at the toll-free number on your member ID card. Applicable FARS/DFARS apply. For a healthcare organization to earn an NCQA Health Plan Accreditation, it is required to meet standards encompassing more than 100 measured elements. 0000001935 00000 n The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Open Choice PPO, Aetna Select, Elect Choice EPO, OA Elect Choice EPO, Open Access Aetna Select NCQA Accreditation as of June 30, 2022 I = Insufficient data; NC = No Credit; NA = Not Applicable Contact us at My.NCQA to ask about licensing the ratings data for research or display. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Ready to learn more about the NCQA certification process? CPT only copyright 2015 American Medical Association. Our provider network increased 6% in 2021.
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