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News

The Centers for Medicare & Medicaid Services (CMS) requires that providers complete training related to Medicare fraud, waste and abuse (FWA) on an annual basis.

Have you taken a course yet? Visit www.AetnaEducation.com and select the “Medicare Advantage Plans” course catalog to access.

If you already completed FWA training offered by another Medicare Advantage organization or Part D Plan Sponsor, you do not need to complete the Aetna FWA training or provide a completion attestation, which may have been required by other organizations. We will audit to confirm your compliance with this CMS requirement. As part of the audit process, we may ask that you provide evidence that FWA training materials were provided and FWA training was completed.

Behavioral Health

Medical

According to recent news reports, a new strain of meningitis is especially lethal. It mostly affects men who have sex with men. This strain kills one out of every three people who are infected. Fortunately, standard meningococcal vaccines have proven effective against the strain.

Our vaccine coverage policy
As a reminder, we cover the meningococcal vaccine as described in our clinical policy bulletin (CPB) #0356. If you treat members in this newly identified risk group or any other risk group that the CPB identifies, we consider the vaccine a medically necessary preventive service. This is according to the Centers for Disease Control and Prevention's recommendations.

View coverage information
Please see our coverage policy. You can check member eligibility and benefits information through our secure provider website.

In-office Surgical Pathology Payment Policy

To allow providers the time needed to acquire these certifications we are delaying the implementation of this policy. This policy will now go into effect April 1, 2013.

We will require Aetna participating providers who perform in-office surgical pathology testing to be accredited by CLIA and at least one other accrediting entity. Dermatologists are exempt from this requirement (disregard the July 2012 letter you may have received).

Pharmacy

  • Drug recall: generic form of Lipitor (atorvastatin)
    On November 9, 2012, Ranbaxy Laboratories issued a retail-level voluntary recall of multiple lots of atorvastatin 10 mg, 20 mg and 40 mg tablets. Ranbaxy issued this recall because some lots may contain a foreign substance (small glass particles of less than 1 mm). To be cautious, they are proactively recalling the drug product lots.

    They manufactured the affected lots between September 25, 2012 and October 26, 2012. The lots were available to members between September 25, 2012 and November 9, 2012.

    Where to go for more information

    • Call Ranbaxy Pharmaceuticals at 1-888-RANBAXY (1-888-726-2299) 
    • Tell your patients to call their pharmacy with any concerns

    Note: The Aetna Rx Home Delivery® mail-order pharmacies use atorvastatin that another manufacturer (Mylan) produces.

    Generic drugs are still a safe alternative to brand-name drugs
    There are several manufacturers that produce the generic form of Lipitor, atorvastatin. Generics are a safe alternative to costly brand-name drugs. The U.S. Food and Drug Administration (FDA) proves generics to be safe and effective. They are exactly the same as the brand-name drug in strength, purity and quality, and have the same active ingredients.

  • Aetna Pharmacy Management (APM) only uses National Provider Identifiers (NPI) to identify pharmacies during HIPAA standard online transactions. As of March 28, 2009, APM no longer accepts these transactions without an NPI.

Dental

On January 1, 2012, Aetna combined the “Serious Reportable Events and Never Events” policy and the “Hospital Acquired Condition” policy into one “Patient Safety Event” policy. You can view the policy on the secure provider website.

From the website:

  • Select "Aetna Health Plan" from the Plan Central home page.
  • Select "Claims" on the left-hand menu, then "Policy Information (Step 3)" and scroll down to select "Claim Payment and Coding Policies."
  • Search by "P" for "Patient Safety Event" (facility policy), or by "P" for "Professional Fees for 'Never Events'" (professional policy).