Covered services. Kansas Department of Health and Environment – Division of Health Care Finance (KDHE-DHCF) administers the benefits for members of Medicaid. Your Member Handbook shows what services Aetna Better Health of Kansas covers. All services must be medically necessary.
Does Aetna use Caqh?
Aetna uses CAQH ProView for credentialing and recredentialing activities. CAQH’s website provides details on completing the CAQH ProView application and the materials needed to complete your application.
What is network by Aetna?
A network is a group of health care providers. It includes doctors, specialists, dentists, hospitals, surgical centers and other facilities. These health care providers have a contract with us. As part of the contract, they provide services to our members at a certain rate.
How do I cancel my Aetna provider contract?
If you are terminating your contract, you must fax a letter including the provider or entity name that is being terminated, the reason for the termination, Tax ID number and termination date.
What is CAQH and credentialing?
CAQH is an online data repository of credentialing data. Practitioners self report demographic, education and training, work history, malpractice history, and other relevant credentialing information for insurance companies to access.
Do I need a CAQH number?
No. Participation in CAQH ProView is voluntary. Some health plans and other healthcare organizations have requested that their network providers use CAQH ProView starting with their next re-credentialing event.
What is KanCare?
The KanCare program is the State of Kansas’ managed care program. KanCare is provided to all Medicaid and CHIP consumers. Kansas has contracted with three health plans, or managed care organizations ( MCOs ), to coordinate health care for nearly all beneficiaries. The KanCare program began in January 2013.
Is Aetna in Kansas?
Aetna Better Health is supporting health literacy in Kansas by helping our members understand important terms to get them on their way to better health. For a list of health-related words and their meanings view our Member Handbook.
Is Aetna owned by CVS?
CVS Health-owned Aetna on Monday rolled out a plan design that would steer patients toward its parent company’s brick-and-mortar locations — a key concern of antitrust regulators in reviewing the almost $69 billion megamerger that closed in 2019.
Is Aetna a good plan?
Financially, Aetna ranks among the strongest health insurance providers. The company has received an A.M. Best Financial Strength Rating of A (excellent). This means the company is financially strong and has the ability to pay out claims in the future.
What is out-of-pocket maximum Aetna?
In-network: Individual $7,000 / Family $14,000. Out-of-network: Individual Unlimited / Family Unlimited. The out-of-pocket limit is the most you could pay during a coverage period (usually one year) for your share of the cost of covered services. This limit helps you plan for health care expenses.
Why did Aetna send me a check?
Some insurance companies pay the subscriber directly when the provider is not in network. There are several things you can do with the check. You can deposit it and pay for the care with a personal check or credit or debit card.
Why does Aetna keep calling me?
Aetna is performing an automated outbound call to health exchange members who have coverage through Aetna. The call serves two main purposes: To gain consent from members to release their pharmacy records to Aetna.
How long does it take Aetna to approve surgery?
Request authorization at least 15 days before the procedure, unless it’s an emergency. Use the electronic portal to submit the requests and medical records. You can request the service as soon as it is planned. We may be able to authorize up to six months for the patient to get the service done.
What is CAQH in mental health?
CAQH, short for Council for Affordable Quality Healthcare, allows insurance companies to use a single, uniform application for credentialing. Over 900 health plans, hospitals, and healthcare organizations use it and require practitioners to complete their CAQH profile before submitting their application.
How long does it take to complete CAQH?
Completing the initial CAQH ProView profile may take up to two hours; however, preparing yourself for the information requested will reduce the time required to complete your profile.
How do you become a certified CAQH?
Applying for the CORE Certification Seal requires you to notify CAQH CORE that certification testing is complete, respond to CORE Certification Measurement Survey and to submit a CAQH CORE Seal Application, a CAQH CORE HIPAA Attestation, a CAQH CORE Certification Fee for each CAQH CORE Operating Rule transaction you …
What is Pecos certification?
PECOS is the online Medicare enrollment management system which allows you to review information currently on file and withdraw electronically.
How do I get a CAQH provider ID?
To obtain a CAQH provider number, a physician must start by credentialing with a particular health care firm. The organization will request the applicant’s participation in the universal provider data source that CAQH registration provides. All participating agencies can be seen on CAQH’s official website.
What is the difference between Medicaid and KanCare?
Kansas provides Medicaid through a managed care model. KanCare is the program through which the state administers Medicaid. There are three managed care organizations that the state contracts with Sunflower, Amerigroup and United.
Is Medicaid the same as KanCare?
Medicaid in the State of Kansas KanCare is the program through which the State of Kansas administers Medicaid. Launched in January, 2013, KanCare is delivering whole-person, integrated care to more than 415,000 people across the state.
Is Aetna insurance going out of business?
Aetna–along with UnitedHealth Group and Cigna–is sitting out the first year of the state’s health insurance exchange.
Who is Aetna owned by?
Aetna agrees to be acquired by CVS Health Corporation in a transaction valuing Aetna at about $69 billion.
What is another name for Aetna?
We’re changing our name to Aetna Coventry and Aetna have been the same company since 2013. We’re changing our name and logo, but our relationship with you and our members will stay the same.
Does KanCare include dental?
Oral Health Kansas – KanCare. Adults with KanCare insurance are able to receive dental exams and cleanings at least once per year. In addition, United Healthcare will provide one x-ray per year and those with a FE waiver may be eligible to receive dentures at no cost.