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Aetna Spring 2010 Insights: "Provider Contracting is Easier with EchoSign"

Aetna Spring 2010 Insights: "Provider Contracting is Easier with EchoSign"

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Published by EchoSign
Aetna is the first insurance care company to introduce electronic provider contracting, with EchoSign as Aetna's eSignature vendor. EchoSign's electronic signature software conforms to compliance, legal and security requirements.
Aetna is the first insurance care company to introduce electronic provider contracting, with EchoSign as Aetna's eSignature vendor. EchoSign's electronic signature software conforms to compliance, legal and security requirements.

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Published by: EchoSign on Mar 29, 2010
Copyright:Attribution Non-commercial


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OctOber 2006
 Aetna BehavioralHealth Insights
Insid this Iss
Autism and Applied Behavioral Analysis 2
Visit our behavioral health web page 2
 Aetna Behavioral Health Insights
– allelectronic 3
Don’t orget
 Aetna BH Insights
available online 3
Tool helps determine patients’ costs 4
Facilities moving locations 4
Updated EAP Billing Form online 4
HIPAA communications 5
Electronic provider contracting 5
Update your profle 5
Quality Management Program 6
How we determine coverage decisions 7
2009 QM Program evaluation 8
Where to fnd Member Rights andResponsibilities 8
BH Clinical Practice Guidelines 9
Practitioner Treatment Record Criteria 9
Beginning April 1, 2010,
 AppliedBehavior Analysis (ABA) requiresprecertifcation
(where permittedor approved). (ABA is used in thetreatment o Autism SpectrumDisorders.)Go online to our secure provider website via NaviNet
to view a copy o our current Aetna Behavioral Healthprecertifcation list, which includes ulldetails and exclusions.To access the Aetna Behavioral Healthand Employee Assistance Program page:
Log in to our secure provider website.
Choose “Aetna Support Center.”
Select “Doing Business with Aetna”ollowed by “Aetna Beneft Products.”
Appid bhavio Anaysis o qi pifaion
 Aetna BehavioralHealth Insights
Behavioral Health Newsletter
SPrING 2010VOlume 5, ISSue 1
Pifaion qins o psyhoogia andnopsyhoogia sing
Keep the ollowing in mind whenrequesting precertifcation and/orsubmitting claims or psychological andneuropsychological testing:
Precertifcation (where permittedor approved) is required whenneuropsychological or psychologicaltesting is a covered beneft and isrequested or the evaluation o a mentalhealth diagnosis (or example, seriouspsychiatric illness).
Precertifcation is not required whenneuropsychological or psychologicaltesting is a covered beneft and isrequested or the evaluation o amedical diagnosis (or example,traumatic brain injury, stroke,dierentiation o brain damagerom a depressive disorder, epilepsy,hydrocephalus, Alzheimer’s disease,Parkinson’s disease, multiple sclerosisor AIDS). Please check to be surethe member does not have a medicalprecertifcation requirement which may necessitate a reerral.
Pre-surgical clearance: An evaluationby a psychologist or psychiatrist(CPT 90801) is sometimes requiredor pre-operative clearance (such asor obesity surgery). A psychologicalor psychiatric evaluation (as opposedto psychological testing) is a routineoutpatient procedure and does notrequire precertifcation.
48.22.804.1 (3/10)
HIPAA and commnication etween treating providers
Concerns about Health InsurancePortability and Accountability Act(HIPAA) Privacy Rule violations areoccasionally raised as a reason why providers are hesitant to share patienttreatment inormation with other healthcare proessionals. HIPAA was createdto protect people’s protected healthinormation (PHI), not to act as a barrierto the communication between treatingproviders.To help maintain HIPAA compliance,here are some tips when sendingconfdential PHI:
by mail
1. When mailing paper PHI, place therecords in an inner envelope and sealthe envelope. Mark the inner envelopeCONFIDENTIAL.2. Place a shipping label on the innerenvelope.3. Place the frst envelope within a secondenvelope or box.4. Place a DUPLICATE shipping label onthe external envelope or box.5. Confrm package has been received.
by ax
1. Beore axing any PHI, call to confrmthe appropriate ax number.2. Always use a cover sheet markedCONFIDENTIAL with your nameand telephone number as the contactinormation.3. Confrm ax has been received by theintended recipient.
by email
1. Confrm that your computer can sendan encrypted document.2. All PHI must be sent in an encryptedormat. Never include identiyinginormation in the subject line.3. Confrm the recipient’s email addressprior to sending PHI.4. Veriy receipt o encrypted email.
by telephone
1. You may leave messages on a patient’sanswering machine, though careshould be taken to limit the amount o inormation disclosed.2. You may leave a message with a amily member or other person who answersthe phone when the patient is nothome, though proessional judgmentshould be used to ensure that suchdisclosures are limited and in the bestinterest o the patient.3. Reasonable requests rom a patient tocommunicate in a confdential manner,such as at a dierent number, shouldbe accommodated.For more inormation, reer to the U.S.Department o Health and HumanServices website at:
 We ask that you share this inormation with your sta.
Provider contracting is easier with new electronic system
 Aetna is the frst insurance care company to introduce electronic provider contracting.Providers will now be able to receive and sign provider agreements via email, makingthe contracting process aster and more reliable. With this system, providers will enjoy ease o administration, reduced paper clutter and cost savings on postage. We are working with EchoSign as our eSignature vendor. EchoSign’s sotwareconorms to compliance, legal and security requirements. To learn more aboutEchoSign and their eSignature solution, visit
.So be sure to check your inbox – an electronic provider contract or new associates inyour practice may be arriving soon.I we do not have your ofce email address, you can submit it to us:Physicians:
update yor profle,inclding langagesspoken
 We want to be sure our membershave access to your most up-to-date inormation in our providerdirectory, including details such asspecialty ocuses, ofce locations andlanguages spoken.Update your profle online at:
 Autism is considered to be a spectrumo disorders with variable presentationsand severities, leading to the preerreduse o the term Autism SpectrumDisorders (ASD). Among other actors, the increasingawareness o ASD has resulted in earlierand more requent recognition o thecondition, so that when broad diagnosticcriteria are used, the incidence o newly identifed children with ASD may beas high as 6 per 1,000. Despite muchresearch into the causes, treatments andoutcomes, there is no single and correctapproach that universally works best inall circumstances.
being part of the solution
There is clearly a need or commercialhealth insurance to be part o thesolution. Aetna Behavioral Health’sresources, including specialized networks,data analytics, integrated medical andbehavioral health systems, resource andutilization management capabilities,enable us to play an active role incoordinating and helping to manage thehealth care needs o this population.Since most state autism mandates do notapply to sel-unded plans, it is up to theplan sponsor to decide whether they willelect to cover autism. The sel-insuredplan sponsor also decides whether toretain the exclusions or educationalservices in their plan documents (mostdo), thereby eliminating coverage or Applied Behavior Analysis (ABA), which Aetna considers to be educational (assupported in the position papers o the American Academy o Pediatrics andthe National Academy o the Sciences).Sel-unded plan sponsors may chooseto retain the exclusion or educationalservices or ear that coverage o ABA willresult in an unlimited beneft due to theFederal Mental Health Parity Act.This Act requires group health plans(sel-unded or ully-insured) and healthinsurance issuers to ensure that fnancialrequirements (such as copays anddeductibles) and treatment limitations(such as visit limits) applicable tomental health or substance use disorderbenefts are no more restrictive than thepredominant requirements or limitationsapplied to substantially all medical/surgical benefts. Thereore, i a plancontains coverage or ABA, such beneftscannot be any more limited than themedical/surgical benefts. Most Aetnabenefts plans have ew, i any, limits onthe medical/surgical side, resulting inunlimited ABA (absent the educationalexclusion).For ully-insured plans, weexclude ABA i there is an educationalexclusion in the plan documents and i the plan is not subject to a state mandate.
Our stance on mandated coverage
Several state mandates require healthinsurance carriers to recognize andreimburse certifed or licensed providers.Our benefts plans typically requirethat services be provided by licensedclinicians. In the ASD feld, there arepractitioners with credentials indicatingcompetency (ABA certifcation) who would not qualiy or independentlicensure in the jurisdiction in whichthey work. These individuals can now become in-network providers with Aetna Behavioral Health, as well as with other carriers. While Aetna does not support a mandateor autism coverage, we do support review o proposed benefts mandates by anindependent body to assess their medicaland fnancial impact. This is especially true given that the efcacy o ABA may be limited to only a subset o children with ASD. Adding autism coverage would have asignifcant fnancial impact on many policyholders. Thereore, i a state isconsidering the passage o mandatedautism coverage, we would like to seethe ollowing eatures included inthe mandate:
Treatment must be provided by licensedor BACB-certifed ABA providerslocated in the insured’s state
 Application o the mandate to largegroup and public plans only 
Standard utilization review according topolicy terms
Coverage required or evidence-basedtreatment only 
Enhancement and not replacement o existing educational services
From the desk of Mark Friedlander, M.D., National Associate Medical Director, Aetna Behavioral Health
Autism and Applied behavior Analysis
Fast facts on ASD/AbA
Not every child will respond to earlyintensive behavioral interventions,regardless o how much is provided.
I the benefts plan covers ABA andthe plan is subject to the FederalMental Health Parity Act, the plancannot subject ABA to limits thatare more restrictive than the limitsthat exist or medical benefts.(Note: Most Aetna benefts planshave ew, i any, limits on medicalbenefts, resulting in unlimited ABAcoverage.)
Aetna bH Insightsavailale online
Access this month’snewsletter, as well as pastissues, by logging in to oursecure provider website.Search or back issues under“Communications.”

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