Aetna Better Health of Ohio Provider Notification - 09/02/2016

www.aetnabetterhealth.com/ohio

September 2, 2016

Cardiology, Radiology, and Pain Management Prior Authorizations

Dear Colleague:

eviCore healthcare is pleased to announce its continued partnership with Aetna Better Health of Ohio to provide authorization services for members enrolled in Managed Medicaid programs.

Effective 09/26/2016, Aetna Better Health of Ohio members will require prior authorization for Radiology, Cardiology & Pain Management services from eviCore healthcare for dates of service 10/03/2016 and after. Services performed without authorization may be denied for payment, and you may not seek reimbursement from members.

Authorization is required for: (*Denotes New Category)

MRI
PET
CT
Pain Management
Myocardial Perfusion Imaging*

Echo*
Echo Stress*
Diagnostic Heart Catheterization*
Cardiac MR, PET, CT*

Services performed in conjunction with an inpatient stay, 23-hour observation, or emergency room visit are not subject to authorization requirements.

Additionally, eviCore is implementing a change of process for initiating Musculoskeletal pre-certification requests.

Beginning 10/03/2016, online requests for ABH Musculoskeletal procedures will be initiated via the eviCore web portal located at https://evicore.com/Pages/ProviderLogin.aspx. You will need to complete a brief one-time registration to access the web portal, if not already registered. Utilizing the web is the quickest, most efficient way to initiate a request and obtain the status of an existing request. Please note: the contact phone and fax numbers/fax forms will change as well, please see below:

To request an authorization, submit your request online, by phone or fax:

Log onto https://evicore.com/Pages/ProviderLogin.aspx, utilizing the web is the quickest, most efficient way to initiate a request.
Call us at 1-888-693-3211
Fax an eviCore healthcare request form (available online) to 1-844-82AETNA

For urgent requests: If services are required in less than 48 hours due to medically urgent conditions, please call our toll-free number for expedited authorization reviews. Be sure to tell our representative the authorization is for medically urgent care.

We recommend that ordering physicians secure authorizations and pass the authorization numbers to the rendering facilities at the time of scheduling. Authorizations contain authorization numbers and one or more CPT codes specific to the services authorized. If the service(s) listed on the authorization needs to be changed, the rendering facility must contact us for review and authorization prior to claim submission.

Have questions about authorizations? Attend our online orientation! The orientation schedule, program training resources, Clinical Guidelines, CPT codes managed, and fax request forms are available at http://www.medsolutions.com/implementation/aetnabetterhealthoh. Please email our client services department at [email protected] if you have questions or need more information.

Orientation Session Invitation

As part of Aetna Better Health of Ohio's efforts to provide its members with access to high quality, cost-effective care, eviCore healthcare has been selected to provide utilization management programs for Radiology, Cardiology, and Pain Management services. The program will begin accepting authorization requests on September 26th, 2016, for dates of service October 3rd, 2016 and after.

In the coming weeks, eviCore healthcare will be leading orientation sessions designed to assist you and your staff with the new utilization management programs. You will be able to attend the web orientation session that works best for you and your schedule.

During these sessions, we will discuss in detail the precertification requirements for Aetna Better Health of Ohio's members and how to locate additional training materials to navigate the eviCore web portal, https://evicore.com/Pages/ProviderLogin.aspx . Topics to be discussed include the new prior authorization process, accessing information from the website and a review of the Quick Reference Guide. Time and participation permitting, this orientation session will be followed by a question-and-answer session. We encourage you to attend one of these informative sessions to ensure your understanding of the new precertification process.

Web Orientation Sessions

Anyone wishing to attend one of the online web orientation sessions must register in advance. Each online web orientation session is free of charge and will last approximately one hour.

We hope you find one or more of the following times convenient. Session Times will be listed as Central Time so if in the Eastern Time Zone the session will be one hour later.

WebEx may display central times

Date	Day of the Week	Time	Topics Covered
September 12	Monday	8:00 AM Central	Radiology, Cardiology, OB and non-OB Ultrasound
September 15	Thursday	10:00 AM Central	Radiology, Cardiology, OB and non-OB Ultrasound
September 20	Tuesday	12:00 PM Central	Radiology, Cardiology, OB and non-OB Ultrasound
October 5	Wednesday	2:00 PM Central	Radiology, Cardiology, OB and non-OB Ultrasound
September 12	Monday	10:00 AM	Pain Management
September 15	Thursday	2:00 PM Central	Pain Management
September 20	Tuesday	8:00 AM Central	Pain Management
October 5	Wednesday	12:00 PM Central	Pain Management

How to Register

Please read the following instructions carefully to register for and participate in a session:

Once you have chosen a date and time, please go to http://medsolutions.webex.com.
Click on the "Training Center" tab at the top of the Web page.
Find the date and time of the conference you wish to attend by clicking the "Upcoming" tab. All of the Provider Orientation Sessions will be named "Aetna Better Health Provider Training Sessions."
Click "Register."
Enter the registration information.

After you have registered for the conference, you will receive an e-mail containing:

The toll-free phone number and pass code you will need for the audio portion of the conference.
A link to the Web portion of the conference.
The conference password.

Please keep the registration email so you will have the link to the Web conference and the call-in number for the session in which you will be participating.

If you are unable to participate in a session at any of the times listed, you can obtain a copy of the presentation by contacting [email protected]. The presentation is in PDF format. If you need Adobe Reader, you can download it from www.adobe.com/products/reader/.