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    • Our office manual keeps you informed

     

    Our Office Manual for Health Care Professionals is available on our website. For Innovation Health, once on the website, select “Health Care Professionals."

     

    Visit us online to view a copy of your provider manual (if you don’t have Internet access, call our Provider Service Center for a paper copy) as well as information on the following:

     

    •  Policies and procedures 
    •  Patient management and acute care 
    • Our complex case management program and how to refer members
    • Additional health management programs, including disease management, the Aetna Maternity Program, Healthy Lifestyle Coaching and others
    • Member rights and responsibilities
    • How we make utilization management decisions, which are based on coverage and appropriateness of care, and include our policy against financial compensation for denials of coverage
    • Medical Record Criteria, which is a detailed list of elements we require to be documented in a patient’s medical record and is available in the Office Manual for Health Care Professionals.
    • The most up-to-date Aetna Medicare Preferred Drug Lists, Commercial (non-Medicare) Preferred Drug Lists and Consumer Business Preferred Drug List, also known as our formularies.

     

    Our medical directors are available 24 hours a day for specific utilization management  issues. Contact us by visiting our website, calling Provider Services at 1-800-624-0756 (TTY: 711) or calling patient management and precertification staff using the Member Services number on the member’s ID card.

     

    Visit us online for information on how our quality management program can help you and your patients. We integrate quality management and metrics into all that we do, and we encourage you to take a look at the program goals.

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