Aetna, the managed healthcare company that sells insurance and related services, recently began its 2022 Provider Education campaign. Following a 2021 survey, the company found that its providers and staff valued their content. Aetna will offer even more content this year to help support healthcare workers nationwide.
This year’s first Aetna Provider Education Bulletin foreshadows what lengths the company will go to support its providers.
This edition highlighted the following:
- Finding policy changes, material amendments, and provider manual updates.
- Contract effective date verification instructions.
- How to avoid inputting all the claims data into Availity, Aetna’s provider portal, each time a claim is submitted.
- Locating covered services for patients on Availity.
How to Find Aetna’s Policy Changes, Amendments, and Manual Updates
Aetna gives providers several alternatives to keep current with its policies. The company’s provider manuals, newsletter, and website have updated information that providers can access anytime.
Aetna’s provider manuals
Providers can download PDF guides when they need support treating patients and managing their practice. The guides can help people understand Aetna’s processes, procedures, products, and programs.
- Aetna At a Glance: offers basic help with the provider website, submitting claims, and more.
- Provider and Facility Participation Criteria: this gives providers everything they need to know about participation in the Aetna provider network.
- Office Manual for Health Care Professionals: contains Aetna’s policies, procedures, and contact information.
- Aetna Premier Care Network Provider Overview: provides general network information.
- Behavioral Health Provider Manual: has information about Aetna’s specialty programs and clinical practice guidelines.
- Employee Assistance Program Manual: details Aetna’s referral process, quality standards, credentialing, and reimbursement procedures.
- Women’s Health Program and Policies Manual: presents information about Aetna’s women’s health program.
- Aetna Product Overview: gives providers a simple product summary.
- Delegation Provider Guide: assists contracting delegates and their staff in understanding how to perform delegated functions by Aetna’s standards.
Aetna OfficeLink Updates
Aetna’s provider newsletter, OfficeLink Updates, publishes updates, important reminders, and material changes about plans, procedures, coverage, drug lists, and more. Interested parties can subscribe to the newsletter email distribution list. If anyone has missed a newsletter, they can search the online archive. They can find past and current editions of every provider newsletter.
Aetna.com
Aetna posts clinical policy bulletins on its website. The bulletins describe the services and procedures Aetna considers necessary, cosmetic, experimental, and unproven. Aetna gathers the data from published medical journals, expert opinions of health care professionals, and nationally-recognized guidelines.
Users can also view updates to Aetna’s medical policies by selecting the What’s New tab on the website. Results can be sorted by the status of information (New, Revised, Updated, and Deleted) and date.
How to Verify an Aetna’s Contract Effective Date
Providers and practice staff can find their contract’s effective date in their countersigned Aetna agreement. It can also be found in the welcome email that Aetna sends once the contract is loaded into their system. Additionally, providers and staff can use the Contact Us feature under the Applications tab when they sign into Availity.
How to Avoid Inputting Claims Data Every Time a Claim is Submitted
Providers and practice staff should run an Eligibility & Benefits Inquiry on Availity before they perform any other transaction. This allows member/patient information to auto-populate the following transaction screen. Availity also offers providers an Express Entry feature. First, users must add a provider to an active organization. Users can then use the drop-down menu in the provider field to auto-populate provider information, eliminating extraneous work.
How to Find Covered Services for Patients via Availity
Patients’ benefits coverage can be accessed via Availity in two ways:
- through an Eligibility & Benefits Inquiry, or
- by viewing benefits by selecting an item from the drop-down list.
Aetna’s Webinars
Aetna invites providers to attend Doing Business with Aetna, a series of webinars that teach providers how to work with Aetna quickly and simply. The series occurs on the second Tuesday or the third Wednesday of each month. They run from 1:00 PM to 2:15 PM ET. Attendees can learn more about the following:
- Discovering provider manuals, clinical policy bulletins, and payment policies.
- Accessing online transactions.
- Registering for other instructional webinars.
- Acquiring online forms.
- Navigating the provider referral and Medicare directories.
- Modifying provider data.
Aetna is dedicated to helping its providers spend less time on administration so they can focus on patient care. Primoris Credentialing Network shares this mission by offering providers 54+ non-delegated and delegated provider enrollment options.
Primoris’ Delegated Agreement with Aetna
Primoris and its clients enjoy a delegated agreement with Aetna, which results in quicker provider enrollment. What is provider enrollment? How important and complicated is it? What exactly is Primoris Credentialing Network? What can a delegated agreement do for providers?
What is Provider Enrollment?
Provider enrollment is crucial to the medical revenue cycle. Many patients rely on insurance to cover their medical bills. They usually prefer going to a physician who is an in-network provider on their insurance plan, so they do not have to pay much out of pocket.
Providers rely on insurance programs, too. A provider cannot correctly invoice for services rendered to a patient unless that provider is enrolled adequately with a payor. Practices can lose revenue if the provider is not quickly and efficiently enrolled with the appropriate health plan(s). Provider enrollment is not as simple as sending applications to different insurance companies.
There are three stages of the provider enrollment process:
- Primary Source Verification of a Provider’s Credentials: Credentialing can identify providers who are unqualified to treat patients, possibly decreasing patient injuries and deaths as well as claims and lawsuits. The procedure includes the traditional credentialing process (52+ steps), often requiring information to go back and forth between the payor and provider.
- Payor Application: Providers must apply to health plans according to each one’s guidelines.
- Contracting: Plans send contracts to providers to review and sign.
Some medical practices perform the provider enrollment process themselves. Untrained office staff and inadequate computer software can cause wasted time, money, and mistakes that can delay enrollment. Errors can halt the entire process. If providers cannot bill, then they cannot bring in money. Medical practices today cannot afford the costly time and money-consuming headaches.
One way practices can eliminate delayed payments to providers and possibly increase their revenue is to outsource the entire provider enrollment process. A provider enrollment company like Primoris can result in several advantages, including streamlined budgeting and access to experts.
What is Primoris Credentialing Network?
One of the country’s only credentialing independent practice associations (IPA), Primoris offers 54+ health plan and network options for provider enrollment. Primoris services providers in Illinois, Texas, and Missouri and is the largest credentialing IPA in the Midwest United States. Primoris collaborates with its’ sister company, 5ACVO, to complete primary source verification, expediting enrollment even more. This cooperation can make a world of difference when it comes to time.
Keeping the process as simple as possible is another critical component of Primoris’ success. 1000s of providers benefit from the company’s administrative simplicity:
- ONE Application: Provider health plan enrollment includes enrollment in some 25+ delegated health plans and networks via one application. Providers must not stress out because they must apply for each plan.
- ONE Point of Contact: Primoris offers its members one point of contact for all delegated and non-delegated enrollment. Providers only have to keep track of one phone number and email address.
- ONE Experienced Team: Primoris is backed by 385+ years of combined industry experience. This knowledgeable team has developed the enrollment process, streamlining it to near perfection.
- ONE Member Portal: The Primoris Credentialing Web Portal provides users easy access to all their credentialing data files. One login on one web portal is all providers need to view their files.
Administrative simplicity enables Primoris to enroll providers faster so they can begin billing sooner. Primoris is a company whose sole dedication is provider enrollment. They can give the proper amount of attention to the process so providers can start to bring in revenue promptly.
Delegated and Non-delegated Contracts
Providers depend on being swiftly enrolled in health plans and networks. The sooner a provider is enrolled, the faster they can see patients and begin billing. Providers have learned to lean on the speed Primoris offers them. Delegated contracts can create faster provider health plan enrollment. Delegated contracts with these health plans and networks allow Primoris to use one application to add a provider more rapidly than the traditional method of sending an application to each health plan.
Primoris works with both delegated and non-delegated contracts. They can perform all the administrative and functional duties related to completing both types of contracts. Delegated by most major plans in Oklahoma, the company is adding dozens of plans in Illinois, Missouri, and Texas.
Primoris’ current delegated health plan enrollment options include:
- Aetna
- Beech Street
- Evolutions Healthcare Systems
- First Health
- Fortified Provider Network
- Galaxy Health Network
- Generations Healthcare Network
- GlobalHealth
- Healthcare Highways
- HealthSmart
- Humana
- Longevity Health Plan
- MultiPlan
- Prime Health Services
- United Healthcare
Primoris’ experienced team of specialists can utilize many non-delegated plan options, including:
- BlueCross BlueShield of Oklahoma
- CareATC
- Cigna
- CommunityCare
- CorVel
- EyeMed
- HealthChoice
- Indian Health Service
- Insure Oklahoma
- Integris
- Medicare
- Oklahoma Corrections
- Oklahoma Rehabilitation Services
- OSMA Health
- Preferred Community Choice PPO
- TRICARE
- TriWest Healthcare Alliance
- U.S. Department of Veterans Affairs – Veterans Health Administration
- USA Managed Care Organization
- WellFirst Health
- WorkNet CommunityCare
Primoris has spent many years forging relationships with these companies. Their connections can empower providers to begin billing as soon as possible. This flexible arrangement can prove to benefit providers no matter the contract type. One application is all it takes for a provider to be enrolled in various health plans and networks.
Aetna and Primoris
Providers who want to enroll in Aetna can do so through Primoris Credentialing Network. With minimal hassles, they can count on 385+ years of experience and expertise to see them through the process. Since Aetna is a delegated option, the process should not take too long. When providers are enrolled, they should expect to receive exceptional support from Aetna. Their goal is like Primoris’. They want to make care easier. Providers and staff can find all the forms they need in one place to focus on patient care. Providers can access easily-found online resources to stay current with laws, policies, and plan updates.
Primoris wants to make provider enrollment easy so providers can get to work as soon as possible. Primoris continuously increases its relationships to expand enrollment options. Providers are promptly notified when a new plan is added to Primoris’ growing list, sometimes before the opportunity is announced locally. More choices coupled with transparent and simplified features permit Primoris to fulfill its mission: to be the largest credentialing and provider enrollment IPA in the United States with a reputation of honesty, humility, and dependability.
More information about Primoris Credentialing Network
Primoris Credentialing Network is a NCQA Credentialing Accredited specializing in credentialing and provider enrollment with 54+ health plan and network provider enrollment options. Primoris is a family member of Fifth Avenue Healthcare Services. Sister companies include 5ACVO (credentialing and primary source verification specialists) and Fifth Avenue Agency (MPLI and medical malpractice specialists).
Primoris Credentialing Network originally published this article here. For more information on Primoris Credentialing Network, please visit PrimorisCredentialingNetwork.com or Contact Us.
