On December 1st, 2021, Aetna launches a new Third-Party claim and Code Review Program. Providers may receive medical records for certain claims. Read along to find out which services and claims are affected!
Starting from December 1st, 2021, providers may start experiencing claim denials, as well as delays in payments due to the implementation of new claim edits by Aetna.
Namely, providers should expect to receive medical records requests for high-dollar claims, claims with bundled procedures, as well as claims filed for implants. Such an integrity review is said to be performed in an effort to make sure that the services are coded correctly. In addition, Aetna has introduced a set of new billing guidelines for its Medicare Advantage plans that have previously been applicable only to commercial policies. First, Aetna will no longer pay for any procedures submitted under the Place of Service Code 99 (other), requiring to demonstrate a more specific place of service. Second, effective 10/01/2021 providers may report telephone services codes (99441 – 99443) only once per 7 calendar days. Finally, ophthalmology providers may now report the CPT code 92014 (comprehensive eye exam for an established patient) only once per 6 months for Medicare Advantage plan patients.
We would like to remind you that proper coding of your services is key to a successful reimbursement flow. We Can Help your practice rock at your medical billing!
A full list of claim edits may be found on the Availity provider portal.
Source:
aetna.com
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