Soon Aetna will delegate a review of applicable medical necessity criteria prior to authorization of services if those are performed in a specific setting.
Effective December 1, 2021, Aetna will implement a Site of Care medical necessity requirement review for services performed on commercial plans members. The medical necessity of radiology imaging procedures (MR and CT scans) will be reviewed by eviCore upon obtaining authorization for service in the hospital outpatient setting.
Source: https://www.aetna.com/content/dam/aetna/pdfs/olu/officelink-updates-sep-2021-olu.pdf
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