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Aetna
Aetna Vaccine Rate Notice
Kids Health First announced a new Aetna amendment effective 12/15/2024 that secured an overall 13% increase over previous rates. We would like to explain the slight decrease in the vaccine fee schedule. In the new amendment, the previously contracted Cost of Living Adjustment (COLA) rate was not applied to vaccines. Aetna has a contracting policy not to place a COLA on vaccines. In KHF’s 2021 contract, Aetna included a COLA as an oversight and KHF practices benefitted from Aetna’s inadvertent addition for 3 years. With the renegotiation in 2024, Aetna reverted to their normal contracting process resulting in the vaccine decrease. KHF completed a comparison to other contracted payors and confirmed Aetna remains the payor with the highest vaccine fee schedule. If you have further questions about the vaccines or the fee schedules, please contact payorconcerns@khfirst.com.
New Edits in Claim and Code Review Program
Beginning June 1, 2025, practices may see new claim edits. These are part of Aetna’s Claim and Code Review Program. You can view these edits on their provider portal on Availity.
For coding changes, go to Aetna Payer Space > Resources > Search > Expanded Claim Edits. OfficeLink Updates
Updates to Pharmacy Drug Lists
On July 1, 2025, there will be updates to Aetna pharmacy drug lists. Changes may affect all drug lists, precertification, step therapy and quantity limit programs. Practices will be able to view the changes as early as May 1, 2025, on the Formularies and Pharmacy Clinical Policy Bulletins page. OfficeLink Updates
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