|
THIRD PARTY UPDATES
From third party chair: Dr. Jonathan Olmes
We have received information from Maine doctors that Aetna has started a down coding program. We wanted to make you aware and provide some resources.
Below is some information from the AOA that you may find helpful. Aetna has this down coding program in place in many states around the Northeast,
Thanks for always communicating, it is very helpful.
Let me know if this information from the AOA/TPC is helpful for you.
-
Has your practice experienced down coding from Aetna or other carrier? email: moa@maineeyedoctors.org
-
Also, please call to report the down coding to AOA stopplanabuses@aoa.org
- appealing is your best first step before we can ask for a secondary Aetna review to get doctors out of this program
- Keep MOA updated on appeal results and other issues
By following these links, you will find a template appeal letter and an example of strong documentation to support the level of care provided. Strong documentation is critical to successful appeals. A template for appeals related to 99xxx codes is available here
If you have any difficulty accessing materials, or questions about third party issues please reach out the the moa office.
|