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Medicare resources for providers

Find information about Aetna Medicare Advantage plans, compliance and attestation requirements, training, enrollment, appeals and more.

Aetna Medicare Advantage plans include any of the following:

 

Aetna Medicare Advantage (MA) plans include HMO, PPO and SNP (Special Needs Plans) benefits to Medicare-qualified members. Aetna offers Duals Special Needs Plans (D-SNPs) to members who also receive Medicaid benefits and/or assistance with Medicare premiums or Parts A & B cost-sharing and live in a county where Aetna Medicare offers a D-SNP. D-SNPs include any of the following:

 

  • Dual Eligible Special Needs Plans (D-SNPs)
  • Highly Integrated Dual Special Needs Plans (HIDE-SNPs)
  • Fully Integrated Special Needs Plans (FIDE-SNPs)

The Aetna Medicare-Medicaid (MMP) is not a Medicare Advantage plan. The MMP is a plan that provides coordinated Medicare and Medicaid benefits for dually eligible individuals.

 

Aetna Medicare Advantage quick reference guide (PDF)

 

Medicare compliance training and attestation

 

Annual Medicare compliance program requirements

 

Every year, all providers who participate in our MA plans are required to meet the Centers for Medicare & Medicaid Services (CMS) compliance program requirements for first-tier, downstream and related entities (FDR). You can find these requirements in the guide and training below.

 

Keep in mind: Our compliance team completes yearly random audits to ensure compliance.

 

Required compliance and training

 

Review Aetna FDR Medicare compliance guide (PDF)

Required for all Medicare providers/delegates, regardless of the type of plan.

 

Review SNP Model of Care/MOC training (PDF)

Required for all providers/delegates treating SNPs members.

 

Questions about compliance requirements? We’re here to help.

 

For more information and contact details, check out our frequently asked questions for providers and delegates (PDF).

Annual Medicare compliance attestations

 

Once you’ve reviewed required compliance and training, you can complete your yearly attestation, if required. This guide can help you with the next steps.

 

Medicare plan(s)

Attestation requirements

MA only

MA and MMP plans

Attestation is not required. However, you must meet the requirements in our FDR compliance guide (PDF).

MA and SNP plans

Attestation is required. Simply complete your training and attestation by December 31. Complete MA and D-SNP attestation (PDF).

Delegated entities:

MA only

MMP Only

MA and MMP

Attestation is required for first-tier entities. Simply complete your training and attestation by December 31. Complete MA/MMP attestation for first-tier entities (PDF).

Delegated entities:

MA and SNP

Attestation is required for first-tier entities. Simply complete your training and attestation by December 31. Complete MA and/or SNP attestation (PDF).

Medicare plan(s)

MA only

MA and MMP plans

Attestation requirements

Attestation is not required. However, you must meet the requirements in our FDR compliance guide (PDF).

Medicare plan(s)

MA and SNP plans

Attestation requirements

Attestation is required. Simply complete your training and attestation by December 31. Complete MA and D-SNP attestation (PDF).

Medicare plan(s)

Delegated entities:

MA only

MMP Only

MA and MMP

Attestation requirements

Attestation is required for first-tier entities. Simply complete your training and attestation by December 31. Complete MA/MMP attestation for first-tier entities (PDF).

Medicare plan(s)

Delegated entities:

MA and SNP

Attestation requirements

Attestation is required for first-tier entities. Simply complete your training and attestation by December 31. Complete MA and/or SNP attestation (PDF).

Supporting information on our Medicare compliance program requirements

 

You’ll receive notification about annual compliance requirements through Adobe Acrobat Sign email or postcard. You’ll also get updates in our OfficeLink Updates™ newsletters for updates throughout the year.

 

Browse OfficeLink Updates library

 

Additional resources

 

Provider office manual (PDF)

 

FDR compliance newsletters

 

Offshore information (PDF)

Medicare and Dual Special Needs Plans expansion resources

Part D prescriber enrollment requirement

Part D prescriber enrollment requirement

Any health care professional who prescribes drugs to patients with Part D plans must now enroll in the Medicare program or opt out. This will help ensure that patients get their prescriptions without disruption.

 

We welcome pharmacies to the Aetna Medicare Part D pharmacy network. The network includes retail and non­retail pharmacies, both independent and chain.


Learn how to participate in our Part D network

You may have patients who are taking Part D drugs that are not on the plan’s formulary or have utilization management requirements. These members can get a transition supply of their drug under certain circumstances. We can work with you to complete a successful transition and avoid disruption in treatment.

 

More about the Part D transition process (PDF)

Find formularies, prior authorization criteria and step-therapy criteria for our Medicare prescription drug plans.


Find prescription drug information


Find Part D prescription drug prior authorization and exception forms

Join our Medicare Advantage Quality Incentive Program

Join our Medicare Advantage Quality Incentive Program

This program includes ways to promote early detection and assessment of chronic conditions. You provide the care your patients need, while earning incentives. You can participate in this program if: 

 

  • You are a primary care physician with 50 to 749 attributed Aetna Medicare Advantage members
  • You are not participating in another Aetna value-based contract or program

Why join the Aetna Medicare PPO network?

Why join the Aetna Medicare PPO network?

More members are joining our Medicare Advantage Preferred Provider Organization plans. So you’re likely to see more patients with these health plans. You can find more information about these plans and how to join our network.

Additional resources

 

Medicare appeals information

 

Find what you need to know about submitting a dispute or appealing a decision.

 

Learn about the dispute process

 

Medicare appeals for non-participating providers

 

Appealing a Medicare hospital discharge

Determining Medicare coverage

 

The Centers for Medicare & Medicaid Services sometimes makes changes to coverage rules. These National Coverage Determinations (NCDs) may affect patient coverage.

 

Learn about National Coverage Determinations

 

Find Aetna Part B step therapy criteria

 

State of Connecticut retiree for special handling of Part B drugs

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

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