TMA's Payment Advocacy Department has learned Aetna will begin sending physicians letters informing them of their ranking in its Aexcel network in early June. The rankings take effect Jan. 1.
Aetna has not responded to TMA's questions about how many physicians are affected compared with the last designation.
Current Aexcel program information can be found through Aetna's secure provider website NaviNet. After logging in, select "Aetna Support Center," then select "Doing Business with Aetna." Once here, look for "Aexcel Designation" and you'll find an overview of the designation process, including the evaluation components.
TMA encourages physicians to appeal the Aetna ranking if they believe it does not comply with a state law (House Bill 1888) that TMA persuaded the legislature to pass in 2009. That law requires health plans to conform to nationally recognized standards and guidelines when ranking or tiering physicians. Health plans must give physicians:
- Notice of the standards and measures they use before any evaluation period;
- An opportunity to dispute the ranking before publication;
- A minimum of 45 days written notice of the proposed rating, ranking, or tiering, including all methodologies and information used;
- A fair reconsideration process (if timely requested); and
- A written communication of the outcome of the proceeding before publishing the ranking or tiering.
TMA has developed a Physician Ranking Toolkit to help physicians with the appeals process.
TMA is tracking this issue. If you appeal, email a copy (please redact any protected health information) to Liz Jero in TMA's Payment Advocacy Department, or fax it to her at (512)370-1632. Also, please notify her of the result of the appeal or any issues that occur.
Action, May 15, 2013