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Yes, Aetna will review precertification requests because our approvals are effective for a length of time. However, at this time there are some states that have issued orders prohibiting elective procedures. Health care providers are responsible for complying with any applicable state governmental directives that prohibit elective procedures during the COVID-19 pandemic. Aetna’s precertification of a service does not eliminate any obligations or restrictions placed on health care providers by a governmental order.
Prior authorization requests for commercial members are now being approved for 9 months instead of standard 6 months. If providers have already received an approval for 6 months and plan to go over, they will need to call Aetna to extend it for an additional 3 months.
Prior authorization requests for Medicare members are being approved for up to 9 months, but not longer than end of the plan year.
Aetna is suspending a 2% sequestration reduction in payments made to providers, to support them during the COVID-19 pandemic. This applies to claims reimbursements to providers in fee-for service arrangements in Aetna Medicare Advantage plans. The suspension aligns with the CARES Act legislation requiring all health plans to suspend the 2% sequestration reduction in payments from May 1, 2020 to December 31, 2020.
All claims that are based on Medicare payment (Medicare and Medicaid) with dates of service May 1, 2020 through December 31, 2020 will no longer apply the 2% reduction and will be in line with the CARES Act legislation.
The 2% reduction will automatically be removed for those claims where sequestration is applying.
We will evaluate any new legislation and make related policy decisions at the time it occurs.
In response to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA) have released guidance regarding Medicare HEDIS data collection.
CMS has eliminated requirements for the collection of HEDIS data that would normally occur during this time for Medicare Advantage (MA) plans. In alignment with CMS’s decision, NCQA will not be requiring submission of Medicare HEDIS data.
Therefore, Aetna will not be requesting providers to submit additional HEDIS medical records for our Medicare Advantage members at this time.
NCQA is proceeding with the annual requirement to collect HEDIS data for our Commercial members.
Aetna will continue to process medical records that have been received. We do not plan to send out additional requests for HEDIS medical records.
The national priority at this time must be to allow the health care system to focus on addressing the COVID-19 crisis.
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