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Who is responsible for getting pre authorization Aetna?
Your primary care physician (PCP) will give Aetna Better Health of California information about the services that they think you need. An Aetna Better Health of California provider will review the information.
Does Aetna use eviCore for authorization?
Aetna has released a new policy requiring physicians and other healthcare professionals to work with eviCore to pre-authorize peripheral services such as angioplasty, stenting, atherectomy, and intravascular ultrasound (IVUS), effective September 1, 2023.
How long does pre-authorization take?
Pre-authorization can take a few minutes to several days, depending on the complexity of the procedure or service being requested. For example, some medical procedures may require extensive paperwork and review by an insurance provider before they are approved.
What is the first step in the pre-authorization process?
How does Prior Authorization work? The Prior Authorization Process Flow. How Long Do Prior Authorizations Take. Step 1: Check client eligibility. Step 2: Determine if a code or service requires Prior Authorization. Step 3: Find and complete forms. Step 4: Submit a PA request. Step 5: Check the status of an authorization.
Can you submit Aetna claims online?
Online. You can submit claims online or resubmissions through ConnectCenter. This is our free provider claims submission portal via Change Healthcare (formerly known as Emdeon or WebConnect).
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A health plans precertification (or prior authorization) process usually begins with a nurse employed by the health plan completing an initial review of the patients clinical information, which is submitted by the practice, to make sure the requested service meets established guidelines.
What happens if a preauthorization or precertification is denied?
If your request for prior authorization has been denied, you have the right to know why. You can ask your healthcare providers office, but you might get more detailed information by asking the medical management company that denied the request in the first place.
What is a precertification letter?
Pre-certification is a review of an itemized estimate for a treatment or procedure so that you know what is or is not covered before the procedure is done.
Related links
A quick reference guide for health care professionals
Go to the provider search on Aetna.com to access the complete list of participating ancillary services providers. Special programs. BRCA genetic testing. Prior
Aetna Medicare Precertification Unit. P.O. Box 14079. Lexington, KY 40512-4079 printable complaint form and information on how to submit an online complaint.
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