Our claim system edits complex claim scenarios to make sure coding and modifier usage aligns with industry guidelines. For example, we evaluate appropriate utilization of separate and distinct service modifiers as well as the separately identifiable evaluation and management modifiers.
When appropriate, we evaluate claims against the following guidelines:
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The Fight Is In Us site
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Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
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Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Do you want to continue?
