Health care professionals: RelayHealth FAQs

What is the RelayHealth service?
RelayHealth is a secure, Web-based doctor-patient service that makes it easy for patients to communicate with their doctor’s office. They can request appointments, renew prescriptions, ask non-urgent questions, and receive lab results—all from their home computer. This can reduce phone calls, waiting-room time, and the time it takes to travel to their doctor’s office. Patients can use Relay Health’s webVisit® to consult with their doctors about non-urgent medical care needs. An Aetna member's financial responsibility for a webVisit is the same as it is for an office visit.

What are the highlights of this online service?
Aetna members are covered for secure, online doctor-to-patient consultations in all states where Aetna’s participating doctors are also enrolled in the RelayHealth service. Map of Participating States.

  • Aetna members can also make online appointments; get referrals, lab and test results, and order new prescriptions and refills electronically.
  • These services are through a secure Internet connection, and will require members to register and log in to the RelayHealth website.
  • You do not have to collect copays. Your patients pay their copay online through the RelayHealth service as part of the webVisit.
  • RelayHealth will submit webVisit claims to us and send copay reimbursement directly to you. We will remit reimbursement for the balance.

What types of providers does this service include?
Effective January 1, 2008, primary care doctors — specifically, family practice, general medicine, internal medicine, pediatricians and Ob/Gyns, are included, along with certain specialists.

How do doctors benefit from these services?

For many doctors, the ability to discuss non-emergency conditions online with their patients can save time and money. Doctors may find that online, structured communications helps them determine key patient information quickly and decrease misinterpretations caused by language barriers. It also may provide a more accurate record. In addition, patients’ details about their conditions are gathered in an organized way and can free office staff and nurses from triaging information, resulting in a more efficient use of office staff. Office staff also can send online “reminders” to patients about regular health checkups or upcoming appointments, rather than making a phone call or mailing a letter. Finally, online communications offer doctors the flexibility to respond to patients’ e-mail at any time of the night or day.

Why did Aetna decide to cover online consultations?

Aetna is committed to leveraging technology to make it easier for doctors to do business, facilitate communications between doctors and their patients, and help improve patient safety.

How do I join RelayHealth?
To learn more or participate in this service, visit www.RelayHealth.com or call toll free 1-877-744-9682.

How secure are online communications?

Unlike e-mail, which relies on multiple servers across the Internet, RelayHealth uses a single, centrally managed database for doctor-patient communications. These communications cannot be read en route, deleted, copied, or altered. The RelayHealth service requires a sign-in identification and password, and can only be accessed by registered users. Patients using the service can view an audit trail detailing who has accessed their record. If, for example, the patient changes doctors, he/she also can terminate their online relationship with a doctor at any time, which prevents access to any medical information communicated via RelayHealth in the future.

RelayHealth’s website includes office staff and assistants as people who can register to deliver care. Who within the doctors’ office has the authority to reply to a member’s communication? How do members know who is responding?
Doctors can grant access rights to office staff who can scan incoming messages and respond to or triage messages on a doctor's behalf using RelayHealth's Group Inbox. When patients receive a reply from the doctor’s office, it will be clear who has responded — the message will either be sent "From [Doctor]", or "By [staff member] on behalf of [Doctor]". The practice can also establish routing rules that automatically direct RelayHealth messages by category to the most appropriate office staff member. For example, all prescription renewals can be sent directly to a registered nurse, appointment requests to the receptionist, and online consultations to the doctor.

How quickly does a doctor need to respond to a member's online requests?

The RelayHealth format limits the consultation to non-emergency conditions. If the member has a medical emergency or something that requires an immediate answer, he or she should call the doctor’s office or seek emergency care. RelayHealth encourages doctors to respond within 8 hours for each message type, and provides online tools for the practice/doctor to monitor message response times. Each doctor and his/her staff have the ability to set their response time by message type. Summary data by doctor is also reported to the health plan monthly, and monitored by RelayHealth.

How does Relay Health ensure the quality of the provider and member interactions during webVisits?
RelayHealth monitors the turn around time of all webVisits. Visits are guided through a series of medically reviewed, clinically structured pre-interview questions, which help the provider to be more thorough. Information is provided first hand to guide the member and provider to what type of symptoms are appropriate for an online consultations and which ones are more appropriate for an in person office visit.

Is there a special CPT code webVisits should be put under?

The American Medical Association established two unique procedure codes to identify online consultations:

  • 99444 - Physician online evaluation and management.
  • 98969 - Non-physician online assessment and management.

These claims will be handled as any other type of claims submitted to Aetna.

How does the payment cycle for reimbursement work?
Once an eligible webVisit occurs, RelayHealth will:

  • Collect the copay at the time of service, or advise the provider that there may be additional member out-of-pocket expenses they will be required to collect after the claim is paid.
  • Submit a claim to Aetna for reimbursement using the appropriate HIPAA compliant CPT codes effective January 1, 2008.
    • 99444 - Physician online evaluation and management
    • 98969 - Non-physician online assessment and management
  • Aetna will then:
    • Process the claim.
    • Reimburse the provider under their contracted fee schedule.
  • Provider reimbursement levels may vary according to a physician's contract and may vary by market. For example, the average online reimbursement for physicians participating in traditional (non-HMO) plans is $30 in most, but not all markets.

Note: The webVisit is the only interaction that is reimbursable. All other transactions (such as requesting appointments, renewing prescriptions, and obtaining lab results), are for convenience purposes only, they are free of charge to the member, and are not reimbursable to the provider.

Are there any Aetna plans excluded from this offering?

At this time, online visit coverage will not be available to members of Strategic Resource Company (SRC). Members in our Medicare Advantage HMO plan in California are included. Medicare members in other states are not currently included (Note: Chickering members will be able to participate in this service.)

Aetna does not cover telephone consultations, in part because they do not include face-to-face interactions. Online visits also are not face-to-face. Why is this different?

This program is different in several ways. The interaction between patient and doctor is handled in a structured way for limited conditions; the online consultations are only to be used for non-emergency conditions. In addition, the online form provides a framework that helps ensure doctors can collect adequate, condition-specific information that will be useful for making clinically appropriate decisions.

Does Aetna anticipate reduced costs from this program?
Aetna is interested in options that promote access to quality, cost-effective care and result in reduced medical costs. Since this program was recently launched, we continue to study our experience and collect data. It is still early in the process to determine the program’s impact on our costs. We will continue to monitor and assess the results as the program evolves.

How will Aetna members enroll and use these online services?

  • To begin, a member must already have an established relationship with the doctor before online services can be used. The member’s doctor also must already be registered as a participating doctor in the RelayHealth doctor network.
  • The process of registering and using the RelayHealth webVisit feature is easy.
  • A demonstration of how a member can use this online capability is available on www.RelayHealth.com. Doctors can visit this website to view the online demo.
  • Our provider directory shows RelayHealth doctors with this icon:

 

How will a member know if his or her doctor participates in this service?
There are several ways a doctor can be identified.

  • They can be found in our online directory. Members who conduct a search of PCPs or certain specialists will see the following icon if any of the providers returned in searches are part of RelayHealth's network. Clicking on the icon will bring the member to additional content and instructions on how they can register to communicate online with their doctor.
  • Members can ask their doctors if they participate. We anticipate that RelayHealth participating doctors may contact their established patients to make them aware of their relationship with RelayHealth.

Is there a charge for members to use this service?
Patients are charged only their usual copay or coinsurance, as if they were making an office visit. There is no charge for any other “convenience” services, such as requesting an appointment, obtaining lab results, or requesting a prescription refill. A webVisit will be covered by Aetna if the patient’s employer has signed up for this service. A member's financial responsibility for a webVisit is the same as it is for an office visit. Any required copays or deductibles will be charged in the same manner they are applied for office visits. This includes plans that have health funds, when the fund limit has been reached. Participating doctors will be reimbursed for services provided according to the terms of their contract. As always, members' financial responsibility depends on the terms of their plan, which may vary.

If a patient uses the “convenience service” to schedule an office visit, is the patient reminded of his or her visit through a follow up email message?

Yes. The provider may set a “rule” while scheduling the visit to send a reminder notification to the patient regarding their scheduled appointment. This rule can be set to send notification for one or two days in advance of the scheduled appointment. The patient will receive a message in their specified email box letting them know they have a message waiting for them in their RelayHealth account.

How will the member responsibility be calculated in a consumer-directed health plan (CDHP)?

Members in CDHPs who have exhausted their fund limit will be responsible for the cost of the webVisit, just as they would be for an office visit. If a member has not yet met the plan's deductible, the webVisit charge will be applied to the deductible, just as a charge for an office visit would be applied. Provider reimbursement levels may vary according to a physician's contract and may vary by market. For example, the average online reimbursement for physicians participating in traditional (non-HMO) plans is $30 in most, but not all, markets.

Do doctors contracted with RelayHealth pay a fee?

Doctors who contract with RelayHealth pay a monthly fee. Rates for medical groups also are available.RelayHealth representatives can explain the details of the arrangement to any interested doctor or group.

How will webVisits be covered?

  • Aetna will cover the formal, structured online consultation (webVisit) for members who use this service.
  • Members will be able to use their personal credit card or debit card to fulfill their financial responsibility for this service. More details about this are provided during the registration process.

RelayHealth also offers patient care management tools to support preventive and chronic care management. Is Aetna also offering this tool in their program?
Aetna is not actively promoting RelayHealth’s care management tools. However, doctors who participate in RelayHealth’s network have the option to use RelayHealth’s care management tools for all their patients, including Aetna members.

Will disputes over claims related to this program be handled like other Aetna claims?

Yes, members and doctors can use Aetna’s existing processes for claim disputes related to online consultations.

How do Aetna members benefit from these services?

Aetna members can benefit from greater access to their doctors, reduced waiting time for test results, and faster routine communications such as appointment scheduling. In addition, by using online communications to interact with their doctor, members can avoid leaving work for an office visit. Online communications offers members the flexibility to contact their doctor’s office at any time of the day or night. Since doctors can send prescriptions and refills online, patients also avoid additional trips to the pharmacy.

How does Relay Health ensure the quality of the provider and member interactions during webVisits?

RelayHealth monitors the turn around time of all webVisits. Visits are guided through a series of medically reviewed, clinically structured pre-interview questions, which help the provider to be more thorough. Information is provided first hand to guide the member and provider to what type of symptoms are appropriate for an online consultation and which ones are more appropriate for an in person office visit.

How can a physician be sure that a webVisit accurately captures a patient’s true health status or concerns, so that appropriate treatment is recommended to the patient during the webVisit?

The interaction between patient and doctor through a webVisit is handled in a structured way for limited conditions. The online consultation can be used only for non-emergency conditions. The online form provides a framework that helps physicians collect adequate, condition-specific information that will be useful for making clinically appropriate decisions.

Aetna and RelayHealth consider it to be the individual physician’s responsibility to decide how to handle a particular patient’s medical treatment, based on the information and specific symptoms the patient provides through the structured online consultation web screens. The member needs to take this into consideration when deciding how to communicate his or her health concern to the health care provider. The member can choose to use the webVisit, or can contact the health care provider and schedule an office visit. Members can request an office visit appointment using the RelayHealth online communication capabilities at no charge.

Note: if the physician determines an office visit is needed in addition to the webVisit, the member is responsible for both copays, as described in her or her plan. It is important to point out that the member’s physician can waive the fee for a webVisit in these situations. Members can discuss this with their physician, as they would discuss any other financial responsibility matters at any time.

Disputes over claims related to this program are handled like other Aetna claims. Members and physicians can use Aetna’s existing processes for claim disputes related to online consultations.

Do doctors’ liabilities increase/change with online visits?

It has been RelayHealth’s experience that the service does not increase doctors’ liability. It could possibly work to decrease liability since the patient/doctor communication is fully documented.

Will participation in this program be considered in Aetna’s measures of cost-efficiency for Aexcel designation of specialists?
While this service may, support a health care professional’s efficiency, at this time it is not factored into the evaluation process for Aexcel designation.

Will Aetna participating doctors who participate be eligible for increased reimbursement through Aetna’s pay-for-performance programs?
Currently, there are no plans to include participation in RelayHealth services as a measure in Aetna’s pay-for-performance programs.

If a member uses the reimbursable webVisit feature, and the doctor then determines an office visit is required, will the member be charged both the webVisit and office visit copays? If the member is charged twice, is there any recourse?

Aetna and RelayHealth consider it the individual doctor's responsibility, to decide how to handle a particular patient's medical treatment, based on the information and specific symptoms the patient provides through the structured, online consultation Web screens. If the doctor determines an office visit is needed in addition to the webVisit, the member is responsible forboth copays, as described in his or her plan. The member needs to take this into consideration when deciding how to communicate his or her health concern to the doctor. The member can choose to use the webVisit, or, the member can contact the doctor and schedule an office visit. Members can request an office visit appointment using the RelayHealth online communication capabilities at no charge.

It is important to point out that the member's doctor has the ability to waive the fee for a webVisit in these situations. Members can discuss this with their doctor, as they would discuss any other financial responsibility matters, at any time. Aetna and RelayHealth are monitoring how such situations are being handled through reporting metrics. The results will be analyzed to understand frequency of such occurrences and trending patterns. If the results indicate adverse impacts, Aetna and RelayHealth will consider opportunities to reduce the frequency, and to help doctors and members better understand the best way to utilize online consultations.

Is Aetna considering other vendors to work with in offering online services between patients and their doctors?
Aetna assessed a number of companies offering online patient/doctor communications over the past year. Aetna is satisfied with the selection of RelayHealth and is not investigating other vendors at this time. With that said, we are aware of other vendors, of varying technological sophistication, throughout the country.

In the states where RelayHealth's services are available for Aetna members, would all RelayHealth doctors be Aetna-participating doctors as well?

No. RelayHealth recruits and contracts with doctors both in and outside of Aetna’s networks. Doctors contracted with Aetna and RelayHealth can be found with our online directory or through the search tool on www.RelayHealth.com.

Can Aetna participating doctors who are not part of a RelayHealth network charge for online visits through another vendor?

No, the doctor must be participating in Aetna’s network, and must have already signed a contract with RelayHealth to submit charges to Aetna. We are monitoring any claims submitted for this online visit procedure code. Aetna will take steps to recover any improper claim payments.

Can members use doctors who may be in RelayHealth’s network, but not in Aetna’s network?

Aetna members must use an Aetna-participating doctor in order to be reimbursed for a webVisit.

How will you determine satisfaction with this program?

RelayHealth conducts an annual survey of the doctors and patients. An online tool deployed on RelayHealth’s secure servers is used to deliver the survey to the patient or doctor’s e-mail address. The responses are kept confidential. The results are tallied and shared with Aetna in aggregate. RelayHealth can also provide a statistical analysis of Aetna members only to compare to the all survey respondents (non-Aetna).

How many Aetna doctors participate in RelayHealth's networks? How many RelayHealth doctors, including specialists, could Aetna members potentially contact for other services such as scheduling online appointments, and prescription refills?

Members in all states where Aetna’s participating doctors are also enrolled in the RelayHealth service can access those doctors, including specialists, for "free" online services including making appointments, receiving referrals, lab and test results, and electronic prescription and medication refills. The number of doctors changes from month to month. Members can use our online directory to find current doctors. For more information about RelayHealth's network doctors, visit www.RelayHealth.com.

Is there a list of the types of webVisits that can be done between patient and doctor?

Yes, there are over 145 webVisit interviews including both chronic and non-urgent acute symptoms available through RelayHealth. In addition, doctors can customize the list of which webVisits to make available to their patient panel.

How will members know which AMA-approved, service is covered when interacting with the RelayHealth website?
The single webVisit is the only reimbursable aspect of this offering. When preparing to actually complete a webVisit, the RelayHealth website will inform the patient about what aspects of the online visit will be covered. The website also informs the patient of payment options (credit card; debit card, etc). There is no charge for the “convenience services” – setting up an appointment, obtaining a refill, requesting lab results.

What impact will this have on capitation if any?
There are no changes or impacts to doctors who are capitated.

What if a doctor who is not participating in the RelayHealth offering, attempts to bill for an online visit using procedure codes 99444 (Physician online evaluation and management) or 98969 (Non-physician online assessment and management)?
To be reimbursed for such a visit, a doctor must be contracted with both Aetna and RelayHealth. Aetna will monitor any claims submitted for online visits. Aetna will attempt to recover any improper claim payments. Aetna systems have been modified to identify this code for payment.

Can a member join at any time?

Aetna members who have an established relationship with a doctor that is contracted with Aetna and RelayHealth may choose to register with RelayHealth for the services at any time.

At what point during a webVisit does the member eligibility verification occur?

Members first register and then can log in any time. Once logged in, they can choose any of the message categories that their doctor offers – such as scheduling an appointment or conducting a webVisit. When they choose the webVisit option, they select the doctor they want to send the webVisit to, and then verify their health plan. At that point, the eligibility verification occurs before the member begins answering any questions related to the webVisit. If they are eligible, the webVisit is permitted. If not, the member receives a message telling them they are not eligible to conduct the webVisit.

How does RelayHealth prevent a member who is not eligible for a webVisit from submitting one after registering on the RelayHealth website?
RelayHealth runs an eligibility check anytime a patient attempts a WebVisit. At that time, the eligibility check will look at the Group Number, determine that the member is not eligible, and notify the member that he/she will be responsible for the payment of the WebVisit.
Note: Any member who may already have a relationship with a doctor who is contracted with RelayHealth can use the “convenience services” free even if a plan sponsor does not offer this service to its employees.

How can a doctor or group practice learn more about participating in RelayHealth?

Aetna participating doctors interested in learning more about participating in the RelayHealth service can visit www.RelayHealth.com or call toll free 1-877-744-9682.


Pharmacy-related questions:

Can RelayHealth support prescription drug orders and refills utilizing non-Aetna pharmacy programs?
Yes, this online service can support non-Aetna pharmacy plans.

How does the ePrescribing work?

When a member registers to use the RelayHealth service, he/she can select a preferred pharmacy, including Aetna's Rx Home Delivery service, to which the doctor's office should send prescriptions. If a pharmacy has not been selected, the prescription will be directed to the member with a one-time option to electronically route the specific prescription to a pharmacy of their choice. The patient cannot print or alter the prescription. Prescriptions are faxed to the selected pharmacy.

Does RelayHealth support electronic routing of prescriptions to a pharmacy for refills?
Yes, members may send the prescription one time.

In addition to supporting Aetna Pharmacy Management (APM) prescriptions, does RelayHealth support interaction with other retail pharmacies? Are there any exclusions?
Members may use this service to obtain prescriptions from a large list of pharmacies on RelayHealth's website, including most retail pharmacies and APM. The standard Aetna exclusions apply.

Will this service support Aetna Specialty Pharmacy prescriptions with a one-time fill at retail?

At this time, Aetna Specialty Pharmacy prescriptions are not supported through this service. We are evaluating including this at a future date.

Did Aetna consider vendors other than RelayHealth? If so, why did we choose RelayHealth?

We evaluated several vendors, but found RelayHealth to offer the most comprehensive and technically advanced online services to Aetna's members.

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