Based on provisions in the affordable care act and effective january 1, 2015, arizona has. This manual is an extension of your contract with us. The manuals include all provider and provider specific pages. Provider newsletter aetna better health of missouri.
English link opens in new window the 2011 provider manual will remain in effect until dec. With aetna providing certain management services for innovation health plan, your innovation health patients now have access to the following aetna programs. Provider manuals for fy 2020 fy 2020 provider manual for community behavioral. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf download. The hpp provider manual reflects current policies, procedures and applicable changes to our medicaid health partners, chip kidzpartners, and health partners medicare product lines, and is considered an extension of your participating provider agreement.
Learn more about our plans and programs designed to help employees to feel their best, both mentally and physically. Please contact the department of health care services, mental health services division, county support unit if the county contact information needs to be. If you do not have medicare coverage in addition to health net access, your behavioral health service provider will still be mercy maricopa integrated care. View, download and save as a pdf file or print eobs. Care managers will also assure that communication between physical and behavioral health providers occurs. Provider manual health plan contra costa health services. The manual is divided into two major components, a general information and administration chapter and individual program chapters. If you have questions about coverage decisions for one of your aetna behavioral health patients, please call 18886323862. Aetna behavioral health behavioral health providers by town services provider type. The manuals include allprovider and providerspecific pages. We are currently finalizing an updated version for the current calendar year. Ste b jeferson city, mo 65109 10991 nw airworld dr. All medicaid members now get their behavioral health services through a health plan.
The manuals are updated quarterly throughout each fiscal year july june, and are posted one month prior to the effective date. Optum is a national leader in providing physical medicine solutions to the health care market. Optum behavioral health uses clinical criteria based on sound clinical evidence to make coverage determinations, as well as to inform discussions about evidencebased practices and discharge planning. Aetna is the brand name used for products and services provided by one or more of the aetna group of subsidiary companies, including aetna life insurance company and its affiliates aetna. Teladoc and teladoc physicians are independent contractors and are not agents of aetna. The intent of the service provider manual is to present useful information and guidance to providers participating in the louisiana medicaid program. If a member elects to use amwell for virtual behavioral health services, the members benefit plan must have both the. If the provider does not have web access, they may contact cigna behavioral health cbh provider services at 1. It has policies, procedures and contact information. Providers who meet aetna s eligibility requirements should watch for a caqh registration package via u.
Chipas clinical practice guidelines help ensure quality care for our members. Spring 2015 volume 10, issue 1 aetna behavioral health. Aetna officelink updates all regions katz brunner healthcare. Aetna medicaid administrators, llc administers mc for dignity.
Virtual behavioral health services are subject to member cost sharing in accordance with their. Provider and billing manual florida sunshine health. In using its clinical criteria, optum behavioral health takes individual circumstances and the local delivery system into account when. The manual is divided into two major components, a general information and administration chapter. Inform enrollees how and where to obtain behavioral health services. Oct 26, 2017 services and behavioral health services to long term care members agreements, schn and mercy maricopa pay a monthly fee to aetna, as defined in the. Aetna officelink updates nevada preferred healthcare providers. Community mercy health partners, catholic health partners, mercy health. Aetnas office manual for health care professionals is available on our public website. Fall 2015 volume 10, issue 2 aetna behavioral update. We want to work with you to provide timely, safe and effective health care to our members. We created this health care professional office manual for our participating physicians.
If you are a licensed behavioral health professional and are interested in joining our provider network, please contact provider relations at 8007793825, then follow the prompts to the appropriate department. Provider manual for all providers except ca 687 mb download pdf. Provider manual for california providers 686 mb download pdf. Please refer to the covid19 alerts and updates page for specific changes and updates. As a upmc health plan member, you have access to much more than topranked care. Behavioral health care providers can contact staff during normal business hours 8 a. Provider manual this behavioral health provider manual, the eap manual of care residential treatment, partial hospital and intensive. This behavioral health provider manual, the eap manual and other related. Youll find most of the information you need in the provider manual.
Aetna behavioral health medical necessity pdf download. Sep 21, 2015 comprehensive behavioral health provider manual. Aetna behavioral health behavioral health providers by town. Your plan includes online health tools, awardwinning customer service, health and wellness programs, travel coverage, and many more benefits and services. Coordination between behavioral health and physical health services. Dec 3, 2014 as of january 1, 2015, mhnet will adopt aetna medicaid policies of using level of care utilization.
Aetna cook county member countycare transition notice pdf. Optumhealth care solutions, llc provider operations manual. Behavioral health provider resources department of. Our health plan and its subcontractors provide medical, behavioral health, dental. Aetna better health of louisiana 2400 veterans memorial blvd. Beginning october 1, 2015 if you have medicare coverage in addition to health net access dual coverage, your behavioral health service provider will be health net access. Top sites aetna aba provider application 2019 latest. Evening appointment availability, family therapy, group therapy, home visits, play therapy, urgent appointment availability, weekend appointment availability gender. Providers also must comply with the policies and procedures contained in any applicable handbook supplements, including the magellan. If services are not available through an innetwork ohio state provider, students will use the aetna network.
Provider manual for health care providers upmc health plan. Mercy care provider manual chapter 100 mc general terms. Aetna is the brand name used for products and services provided by one or more of the aetna group of companies, including aetna life insurance company and its affiliates aetna. Calendar year cy 2014 hedis 2015 medicaid rates pdf cy 2016 health and quality of life.
Our behavioral health programs focus on the important role of mental health on a persons overall wellbeing. The total health care provider manual is a resource to assist providers and staff in understanding the network structure, products and the policies and procedures of the plan. Ncqa has added an additional standard, which is the care for nonlife threatening emergency appointment, which is. Parkland community health plan provider manual september 2015 2777 stemmons freeway, suite 1750 dallas, tx 75207. The 2017 provider manual is effective immediately for providers with executed agreements dated sept. View, download and save as a pdf or print eobs, as needed. Call us if you have questions about which provider manual you should use. Youll learn which services are covered for our members. Providers must ensure services are delivered in accordance with the medicaid service provider manual and. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf. The electronic medicaid provider manual contains coverage, billing, and reimbursement policies for medicaid, healthy michigan plan, childrens special health care services, maternity outpatient medical services moms, and other healthcare programs administered by the michigan department of health and human services mdhhs.
Health plan provider manual september 2015 2777 stemmons freeway, suite 1750 dallas, tx 75207. Amerihealth caritas louisiana staff will work with the appropriate primary care provider and behavioral health providers to develop an integrated treatment plan for members in need of physical and behavioral health care coordination. Community provider manuals georgia department of behavioral. Screen, evaluate, treat andor refer as medically appropriate any behavioral health problemdisorder. Policy manual west virginia department of health and. Plans and programs for aetna medicare advantage plans participating physicians, hospitals and other health care providers are independent contractors. This guide is intended to be used for quick reference and may not contain all of the necessary information. Provider and billing manual 20152016 ambetter prov15flc00008. Fy 20 th 4 quarter provider manual for community behavioral health providers april 1, 2020 page 5 of 409 summary of changes table updated for april 1, 2020 effective date posted march 1, 2020.
Services mdhhs common formulary that is required under section 1806 of public act 84 of 2015. Aetna has a variety of mental health insurance options to fit employer needs, from standalone behavioral health plans to coverage that integrates with aetna health benefits. Provider responsibilities to aetna better health of michigan. Behavioral health provider prior authorization requests on mhnet portal.
The mental health plan point of authorization directory lists california county mental health office plan names, addresses and telephone numbers. This provider handbook services as a resource and outlines operations for aetna better healths integrated care program and our aetna better health premier plan program. Treat mental health andor substance abuse disorders within the primary care providers scope of practice. Aetna behavioral health behavioral health providers by town test provider type. The medicare access and chip reauthorization act of 2015. Aetna behavioral health medical directors are available 24 hours a day, 7 days a week, to discuss specific concerns and provide additional information. Aetna and its affiliates provide certain management services for innovation health. As an aetna better health of california provider, there are certain procedures and protocols you need to know. Well give you valuable tools to help you work with us and provide highquality service to our members. The combination of kepro and aps healthcare in 2015 created an organization with unequaled experience with utilization management and prior authorization across. Youll also find information about a wide variety of topics, ranging from how to file a claim to. Behavioral health services quick facts and phone guide. Dallas service area for medicaidchipchip perinate dallas, collin, rockwall, kaufman, navarro, hunt and ellis counties. Behavioral health provider manual april 2016 page 2 introduction our company kepro is a qiolike entity designated by the centers for medicare and medicaid services.
And it can help ease your administrative burdens all in one easytoread document. To see a complete list of behavioral health services requiring precertification, view our list online. We hope you find this information and the enclosed documents useful to your office operation and in serving your patients our members. Fall 2015 volume 10, issue 2 aetna behavioral update your. Publications and resources humana behavioral health. English link opens in new window provider manual for california providers 4 mb download pdf. See more information designed specifically for health care providers.
Aetna offers health insurance, as well as dental, vision and other plans, to meet the needs of individuals and families, employers, health care providers and insurance agentsbrokers. Due to the world health organization declaring coronavirus disease covid19 a pandemic, the west virginia bureau for medical services bms has expanded certain services and waived certain requirements that may be listed in the medicaid provider manual. Provider manual for all providers except ca 3 mb download pdf. The magellan national provider handbook outlines the policies and procedures with which providers are required to comply when serving members whose care is managed by magellan andor its affiliated companies. The policies and procedures referenced herein are subject to change as federal or state. Behavioral health appointment waiting times behavioral health providers are required to adhere to standard appointment wait times, regardless of provider type. Aetna better health medicaid and chipchip perinate. Health information programs provide general health information and are not a substitute for diagnosis or treatment by. Ncqa has added an additional standard, which is the care for nonlife threatening emergency appointment, which is within six 6 hours of the request. This manual details our referral process, quality standards, credentialing and reimbursement process.
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