Aetna

New Precerts, Edits From Aetna - 10/05/2018

Aetna will require precertification for endoscopic nasal balloon dilation, effective Nov. 1. This is one of several changes Aetna has announced to its National Precertification List.


Private Payer Round-Up, March 2013 - 04/27/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.


Private Payer Update, June 2012 - 04/20/2018

  In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists (June 2012).


Payer Roundup, October 2017 - 11/06/2017

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. See a reminder about your Physician Compare review, and find out about certain claim rejections, and new health plans and policies  


Payer Roundup, September 2017 - 09/29/2017

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. Find out about a physician ranking deadline, new policies and guidelines, dispute process rules, and more.


Commercial Risk Adjustment: One More Reporting Requirement - 07/28/2017

As part of Aetna’s commercial risk management initiative, a medical records vendor will contact you twice this year on behalf of Aetna. Here are some details about this process, required for all payers.


Private Payer Roundup, May 2017 - 05/26/2017

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. Find out about new preauthorization requirements, new web tools, policy changes, and more.


Collecting Payment for Noncovered Services - 04/19/2017

Can you charge a patient for a service the patient’s health insurance plan doesn’t cover? Answer: It depends.


Payer Roundup, December 2016 - 12/19/2016

In case you missed these — here is a roundup of useful items from Medicare and commercial health plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. Find out about changes for 2017, including in Medicare.


Guide to Preventive Services Covered Under the ACA - 08/31/2016

Can you name all the preventive health services that commercial health plans must cover under the Affordable Care Act (ACA)? Here are some lists, tips, and FAQs, including links to payers’ guides.


Private Payer Roundup, August 2016 - 08/26/2016

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. Find out payment and recertification policy changes and more.


Aetna Deselecting 130 Texas Physicians - 08/01/2016

Aetna has notified 130 Texas physicians it will terminate them from its networks on July 1, TMA's Payment Advocacy Department has learned. Aetna says it told the physicians a year ago it was concerned about their billing patterns. Evaluation and management (E&M) codes were the only ones Aetna examined, and its concern involves primarily levels 4 and 5 E&M codes.


TMA: Insurance Merger Would Limit Patient Choice, Raise Cost - 06/17/2016

A proposed supersize merger in the Texas health insurance market raises concerns about fewer health care options and higher costs for patients, according to Texas Medical Association’s (TMA’s) Texas Medicine magazine.


TMA Tells DOJ Aetna-Humana Merger Would Be Bad for Texas - 06/17/2016

The Texas health insurance market would suffer from reduced competition and potentially higher prices if the federal government approves the pending merger between Humana, Inc. and competing health insurance company Aetna, Inc.


Aetna Aexcel Ranking Letters Coming - 06/13/2016

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.


Modifier 25: The “Separately Identifiable E&M” Modifier - 06/03/2016

Don’t forget to append modifier 25 when warranted, or payers will consider your evaluation and management (E&M) service as part of a procedure, and not pay for it.


Global Surgery: Where to Find Payer Policies - 06/01/2016

When it comes to global surgery — all necessary services a surgeon normally furnishes before, during and after a procedure are included in the payment for the surgery — every payer has its own policies about coding and billing.  Here is a quick guide to payer rules.


Bigger Isn't Always Better - 05/20/2016

As Aetna seeks to acquire Humana Inc. in a $37 billion deal, TMA and physicians across Texas worry the merger would weaken their contract negotiating power with health plans while shrinking already narrow provider networks.


Teacher Retirement System Contract Transfers to Aetna - 05/13/2016

Beginning Sept. 1, 2014, the contract for managing the Texas Teacher Retirement System's TRS-ActiveCare program transfers from Blue Cross and Blue Shield of Texas to Aetna. The change does not impact TRS retirees.


Private Payer Round-Up, February 2014 - 05/13/2016

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA's reimbursement specialists.


Private Payer Round-Up, March 2014 - 05/13/2016

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.


Private Payer Round-Up, June 2014 - 05/13/2016

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.


Private Payer Round-Up, August 2014 - 05/13/2016

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.


Private Payer Round-Up, November 2014 - 05/13/2016

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. Find out about new payment policies for pediatric and neonatal critical and intensive care services, bulk powder compound drugs, certain Medicare Advantage plans, and more.


Private Payer Roundup, February 2015 - 05/13/2016

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. Find out about medical, pharmacy, and payment policy changes, get updates about marketplace plans, and more.