New Precerts, Edits From Aetna
By Ellen Terry

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 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.

 

Aetna recommends you request precertification at least two weeks before the scheduled services, preferably electronically. You can submit most requests through the Aetna website, or by using your electronic health record system portal. You can view full precertification lists on the Aetna website.

Will New Edits Affect You?

Aetna will add new third-party claims edits to its claims adjudication process, effective Dec. 1. To find out if the edits will apply to your claim, use Aetna’s new prospective claims editing disclosure tool. After you log in to the Aetna website, go to Plan Central > Aetna Claims Policy Information > Policy Information > Expanded Claims.

Source: Aetna OfficeLink Updates, September 2018

The Texas Medical Association’s payment specialists continuously review health care payment plans’ newsletters and updates for items important to Texas physicians. Texas Medicine Today periodically publishes key excerpts from those newsletters that you might have missed.

If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy[at]texmed[dot]org for help, or call the TMA Knowledge Center at (800) 880-7955. TMA members can use the TMA Hassle Factor Log to help resolve insurance-related problems. Visit www.texmed.org/GetPaid for more resources and information. 


Last Updated On

October 05, 2018

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Ellen Terry

Project Manager, Client Services

(512) 370-1391

Ellen Terry has been writing, editing, and managing communication projects at TMA since 2000. She hails from Victoria, Texas; has a journalism degree from Texas State University; and loves to read great fiction. Ellen and her husband have two grown sons and a couple of cats.

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