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Fall 2016

Aetna Better Health of Ohio's Provider Portal
 
Aetna Better Health of Ohio is dedicated to providing great service to our providers and our members. That's why our HIPAA-compliant web portal is available 24 hours a day. The Provider Portal is your one-stop destination for looking up prior authorization requirements, checking on the status of a claim, verifying a member's eligibility, and so much more.

For more information visit our website at www.aetnabetterhealth.com/ohio or click here to fill out the Web Portal Registration Form if you are a new user.

Call us at 1-855-364-0974, option 2, or email us at [email protected] if you have any questions.
Get Your Newsletters and Notifications via Email
If you did not receive this newsletter in your email inbox, please click the link below and provide us with your office email address so you can directly receive future Provider Newsletters and Provider Notifications.
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 For the full listing of previous Aetna Better Health of Ohio Provider Notifications click here.

Member Rights & Responsibilities

It is important that Aetna Better Health of Ohio's practitioners are aware that our members have certain rights and responsibilities related to their care and treatment.

Aetna members have a right to:
  • Receive information about Aetna Better Health of Ohio, the services we offer, our practitioners and providers, and member rights and responsibilities.
  • Be treated with respect and recognition of their dignity and their right to privacy.
  • Participate in making decisions about their health care.
  • A candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.
  • Voice complaints or appeals about Aetna Better Health of Ohio or the care we provide.
  • Make recommendations regarding Aetna Better Health of Ohio's member rights and responsibilities policy.

Aetna members also have the responsibility to:

  • Supply information, to the extent possible, that Aetna and our practitioners and providers need in order to provide care.
  • Follow plans and instructions or care that they have agreed to with their practitioners.
  • Understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.

HEDIS®
 
HEDIS (Healthcare Effectiveness Data and Information Set) is a set of standardized performance measures designed by the National Committee for Quality Assurance (NCQA) for the managed care industry. HEDIS is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service.
 
HEDIS performance measures assist you in providing timely and appropriate care for your patients; provide you with a picture of the overall health and wellness of our members, allowing you to identify gaps in care and develop programs/interventions to help increase compliance and improve health outcomes.
 
The PCP HEDIS Documentation Tips: Older Adults serves as a resource guide to assist your practices in documenting the quality care you provide to our MyCare Ohio members.

To Our Skilled Nursing Providers
 
Effective December 31, 2016, Aetna Better Health of Ohio (ABHO) will be ending our relationship with Optum to provide nurse practitioner services to our members in Skilled Nursing Facilities and transitioning to our new vendor, Advance Health.
 
For more information click here to read a message from our COO, Jason Smith, about this change.

Financial Liability For Payment of Services
 
Balance billing enrollees is prohibited under the MyCare Ohio plan. In no event should a provider bill an enrollee (or a person acting on behalf of an enrollee) for payment of fees that are the legal obligation of Aetna Better Health of Ohio. This includes any coinsurance, deductibles, financial penalties, or any other amount in full or in part.
 
Providers must make certain that they are agreeing not to bill an enrollee for medically necessary services covered under the plan and to always notify enrollees prior to rendering services. Providers must also make certain that they are agreeing to clearly advise an enrollee, prior to furnishing a non-covered service, of the enrollee's responsibility to pay the full cost of the services.

Disclaimers
Aetna Better Health® of Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees.
Aetna Better Health® of Ohio complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
 
English: ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-800-385-4104 (TTY: 711).
Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-385-4104 (TTY: 711).
Somali: FEEJIGNAAN: Haddii af-Soomaali aad ku hadasho, adeegyada gargaarka luqadda, oo bilaash ah, ayaad heli kartaa. Wac 1-800-385-4104 (Kuwa Maqalka ku Adag 711).
Nepali: ध्यान दिनुहोस् : तपार्इंले नेपाली बोल्नुहुन्छ भने तपार्इंको निम्ति भाषा सहायता सेवाहरू निःशुल्क रूपमा उपलब्ध छ । फोन गर्नुहोस्  1-800-385-4104 ( टिटिवाइ : 711) ।




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