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D ecem b e r 2 0 0 8 V o l ume 5 , I ssue 6 Aetna OfficeLink Updates ™ Southwest Region Coverage information for influenza vaccines Inside This Issue OfficeWise . . . . . . . . . . . . . . . 2-3 With the influenza season upon us, we want to remind you of our coverage policies for influenza vaccines. Policy and Practice Updates . . . . 4 Aetna’s Education Site for Health Care Professionals. . . . . . 5 n Prescription Medications & Pharmacy Management . . . . . 6-7 Physician Focus. . . . . . . . . . . . . . . 8 Southwest News. . . . . . . . . . 9-10 n Options to reach us Go to www.aetna.com Select “for Health Care Professionals” n Select “Medical” n Select “Log In” or “Register Now!” n W  e consider intranasally administered influenza vaccine (FluMist) a medically necessary alternative to injectable To review coverage details, refer to Clinical Policy Bulletin #0035, Influenza Vaccine, by going to www.aetna.com and choosing “Health Care Professionals,” then “Medical.” Note: While the vast majority of Aetna plans include coverage for influenza vaccination, some plans exclude coverage of preventive services. Please check benefits plan descriptions for details. Copayment information for influenza vaccines: n If the influenza vaccine is… No copayment should be collected if the Aetna Medicare member receives only the vaccine. Received by an Aetna Medicare member who, under their Medicare plan, is permitted to receive the influenza shot or pneumococcal vaccine from an out-of-network provider 1-800-624-0756 for calls related to HMO-based benefits plans and WA Primary Choice plan No copayment should be collected. Received by an Aetna Medicare member, (note that all Aetna Medicare members have direct access to any in-network provider for an influenza shot or pneumococcal vaccine) n Collect the physician office visit copayment. Received at the physician office and not billed as an office visit (no additional services were received) F  or indemnity and PPO-based benefits plans call 1-888-MDAetna (1-888-632-3862) Then…. Received at the physician office and billed as an office visit (additional services received) Or call our Provider Service Center: n W  e consider standard or preservativefree injectable influenza vaccine a medically necessary preventive service for members when influenza immunization is recommended by the member’s doctor. influenza vaccine for immunocompetent healthy persons 2 to 49 years of age. Collect applicable out-of-network coinsurance. Save time and money by sending claims electronically It doesn’t matter how many paper claims you submit each month, or what types of Aetna benefits plans your patients have. Every office can take advantage of electronic claims submission. Benefits of electronic submission Added convenience, increased efficiency and fewer administrative hassles can be yours when you go electronic. You’ll also: n G  et paid faster – Get your claims payments quicker. 23.22.807.1-SW (12/08) n n n n S  ave time – No more getting your claims ready manually. No more mailing delays. S  ave money – Going electronic can be less expensive as you don’t incur costs for postage or paper. n n H  ave peace of mind – We acknowledge electronic claims immediately upon receipt. F  eel secure – Claims go directly from your office to our system, safely and securely. Switch from paper to electronic We offer many vendors and methods for submitting claims electronically. n P  ick a vendor by going to www.aetna.com/provider/medical and selecting “Service Solutions” and “Electronic Connectivity.” S  end professional claims free of charge from our secure provider website via NaviNet®. F  or the technically savvy, submit professional and institutional claims directly to us free of charge via www.aetnaedi.com. OfficeWise Introducing our new Aexcel® clinical performance evaluation standards We are expanding our Aexcel clinical performance criteria, giving physicians more opportunities to meet the clinical performance requirement. This change is the result of input from NCQA, an independent organization that monitors our Aexcel program in Metro New York. We will re-evaluate physicians in all Aexcel markets with the new clinical performance criteria in early 2009 for the 2010 Aexcel designation cycle. These changes are already in effect for Metro New York. n n n Fulfilling the clinical performance requirement Now, specialists must fulfill at least one of the following clinical performance criteria to be considered for Aexcel designation: n M  eet the established threshold for clinical performance on claims-based measures recognized by respected professional organizations, such as the American College of Cardiology. n A  t least 75% of specialists in the group are recognized by either Bridges to Excellence or National Committee for Quality Assurance through their recognition programs in the areas of diabetes, cardiac/stroke or low back/spine. A  t least 75% of specialists in the group maintain current, active Board Certification by an ABMS or AOA recognized Board in their Aexcel specialty. Note: board eligible status does not meet this requirement T  he physician or group has earned the Physician Office Link designation or, upon reconsideration, informs us of the use of health information technology which applies National Quality Forum-endorsed measures. T  he physician maintains an active medical staff appointment at an Aetna Institutes of Quality (IOQ) facility and his/her primary specialty is the specialty for which the facility is recognized for IOQ. IOQ is a designation for facilities that have demonstrated quality care based on measures of clinical performance, access and efficiency. New claims-based measures added for 2010 We are also adding five new claimsbased measures to the Aexcel program for the 2010 Aexcel designation cycle: n n n F  or orthopedists, osteoporosis management following a fracture F  or neurologists, anticonvulsant therapy monitoring F  or cardiologists, ACE inhibitor/ ARB, digoxin and diuretic monitoring In addition, we are removing the following claims-based measure: n F  or Ob/Gyns, HIV testing for pregnant patients Clarification: Coverage for HPV testing Submit CPT Category II codes We want to clarify an article about coverage for human papillomavirus (HPV) testing that ran in the August 2008 issue of Aetna OfficeLink Updates. So we can better serve your patients, we are requesting CPT Category II codes on all claims generated by face-to-face patient visits. HPV testing is covered for women under age 30 when ordered as a reflex to an abnormal Pap test. It is also covered for women age 30 and over when ordered with a Pap test. If both the Pap and HPV are normal, current literature indicates that the tests do not need to be repeated for three years. 2 Aetna OfficeLink Updates In certain cases, we consider HPV testing experimental or investigational. HPV is not covered when ordered on women under 30, unless the Pap test is abnormal. For more information, refer to Clinical Policy Bulletin #0443 at www.aetna.com and choosing “Health Care Professionals,” then “Medical.” CPT Category II codes give us more detailed clinical information than we would get from CPT-4 codes. This additional information can impact Care Consideration alerts, as well as our disease and quality management efforts. OfficeWise How to check eligibility and benefits You can verify eligibility and benefits through our secure provider website via NaviNet or through Aetna Voice Advantage®, our interactive telephone self-service system. These tools also provide information on patient cost sharing, including deductibles, copays, and specific plan or annual benefits maximums. To facilitate payment accuracy, we encourage physician offices to verify eligibility and benefits information before billing patients. This is especially important given the variety of plan designs we offer to meet your patients’ wide-ranging needs. What’s new on our secure provider website We’re continually refreshing our secure provider website via NaviNet to give you access to the latest tools and resources for doing business with us. Highlights of recent site content updates include: AETNA SUPPORT CENTER: n n n n n n n A  dded Aetna OfficeLink Updates™ – October 2008 issue U  pdated Health Care Professional Toolkit U  pdated Employee Assistance Program (EAP) links to forms U  pdated Aetna Behavioral Health Provider Manual U  pdated Aetna Depression Management Program PCP flyer n A  dded new link under Aetna Specialty Pharmacy® Self-Injectable Medications section for Xolair® (Omalizumab) Injectable Medication Precertification Request for Subcutaneous Use form n n U  pdated information on Preventive Services Guidelines page for colorectal cancer screening A  dded Xolair® (Omalizumab) Injectable Medication Precertification Request for Subcutaneous Use form A  dded Fall Assessment Charting Tool and Physician Communication PostFragility Fracture Care form n S  ee the feature article in this issue for updates to our Education Site for Health Care Professionals U  pdated EAP forms and descriptions for: n E  AP Provider Billing Form n C  ase Activity Form – EAP Provider n U  nder Network-Based Medicare Advantage Plans, added new link for Texas dual eligible program S  tatement of Understanding EDUCATION: Forms Library n C  onsent for Release of Information n Clinical Resources n C  onsent for Release of Information to Employer n Pharmacy Doing Business With Aetna n U  nder Non-Network Based Medicare Advantage Plans, updated information and links for Aetna Medicare OpenSM Plan (PFFS) C  ase Activity Form – EAP Participant HEDIS® 2008 results available Thanks for your help with our HEDIS1 2008 data collection efforts. We have submitted our data in accordance with NCQA2 reporting requirements. You can view our 2008 HEDIS results at www. aetna.com/members/health_wellness/ support_tools/quality_report_cards.html. We annually collect HEDIS data from claims, encounters and other administrative data, as well as from chart reviews for certain clinical measures. We may conduct chart reviews for HEDIS measures such as Controlling High Blood Pressure and Cholesterol Management After Acute Cardiovascular Events (LDL-C control component). We analyze these results to: n n n I  dentify opportunities for improvement. D  esign and implement quality improvement activities. 1 HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA) that stands for Healthcare Evaluation Data and Information Set. 2 NCQA is a registered trademark of the National Committee for Quality Assurance. E  xamine the underlying causes for suboptimal performance. December 2008 3 Policy and Practice Updates Clinical, payment and coding policy changes We regularly adjust our clinical, payment and coding policy positions as part of our ongoing policy review processes. In developing our policies, we may consult with external professional organizations, medical societies and the independent Physician Advisory Board, which provides advice to us on issues of importance to physicians. The accompanying chart outlines coding and policy changes: Code(s) Impacted Procedure What’s Changed Implementation Date 27194 Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation, with manipulation, requiring more than local anesthesia Pelvis will be added to the list of body joint disorders that are considered experimental for manipulation under anesthesia (MUA) in Clinical Policy Bulletin #0204. March 1, 2009 N/A Calculation of anesthesia time units Anesthesia time units will be calculated to the nearest tenth (for example, 2.6) rather than the nearest whole number for traditional products. This change provides consistency in anesthesia time unit calculations for our HMO and traditional products. March 1, 2009 Modifier 59 restrictions Specific ambulance and ECG codes Aetna considers 93000-93010 and 93040-93042 (ECG codes) incidental to A0225, A0426-A0431 and A0433-A0434 (ambulance codes). Modifier 59 will not override these code combinations when billed. May 4, 2009 S9083 Global fee urgent care centers All CPT and HCPCS codes will be denied as incidental when billed with S9083. Modifier 59 will be restricted to not override the incidental edit. May 4, 2009 Preventive medicine counseling 99401-99404 will be denied when billed with 99381-99397. May 4, 2009 99401–99404 will be allowed when billed with 99201–99215, but only when appended with Modifier 25. Correct Coding Initiative (CCI) edits restricting Modifier 59 – Correction Provider office site visit policy changes NCQA no longer requires us to conduct initial office assessments of primary care physicians and Ob/Gyns who are interested in joining the Aetna network. We will only conduct office site visits and audits of physician practices to follow up on service-related complaints from members. These complaints can pertain to: n A  ccess and accessibility issues n U  nsanitary or unsafe office conditions n P  rivacy or confidentiality concerns n M  edical record-keeping practices 4 Aetna OfficeLink Updates In the October 2008 edition of OfficeLink Updates, we communicated CMS CCI edits that will restrict the use of Modifier 59. The following code combinations will not be included in this policy change as previously indicated: N/A 90471 + 90467 and 90473 + 90465 Steps for BRCA testing approval BRCA genetic tests are authorized through our Women’s Health department, with the help of Myriad Genetics. To request approval for a BRCA test for a female patient, our Women’s Health department must authorize this test. Please do not send a request for approval through another electronic payer. Our Women’s Health department will coordinate this for you by working with Myriad Genetics – simply call our Women’s Health BRCA line at 1-877-794-8720. Check our Medicare formulary for updates The Aetna Medicare Preferred Drug List, also known as our formulary, has changed for 2009. For comprehensive information, effective January 1, 2009, please visit https://www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp. For a paper copy of our formulary guide, please call 1-800-AetnaRx (1-800-238-6279). Aetna’s Education Site for Health Care Professionals Learning Opportunities From Aetna....Developed With You In Mind New and updated courses for physicians, nurses and office staff O  ffice Administration n X Orientation: Getting started with Aetna… A guided orientation X Electronic Connectivity: EDI Calculator NEW NEW n R  ecorded Events n Electronic EOB Tool recorded webinar We also offer Aetna in-service, face-to-face sessions and live webinars. For upcoming events, see our calendar on the Education Site. To get started, visit our secure provider website via NaviNet and click on the Education link from the Aetna Plan Central home page. R  eference Tools X Consumer-Directed Health Plans (CDHPs) reference tool NEW “Stepping It Up” at the Annual 2008 MGMA Conference Download our new course catalog It’s easier than ever to find courses with our new downloadable, printable course catalog. Explore our wide range of courses at http://aetnaofficelink. providerpreference.com/files/ Education_Catalog.pdf. Go electronic and save Looking for ways to reduce your practice’s expenses? Consider doing business with us electronically. Our updated, easy-to-use EDI Savings Calculator shows your potential monthly and annual savings by submitting these transactions electronically: Thank you for stopping by our booth at October’s Medical Group Management Association (MGMA) 2008 Annual Conference at the San Diego Convention Center. We look forward to opportunities for face-to-face time with physicians and their office staff. This year’s booth focused on enhancements to our secure provider website – specifically your ability to electronically access clinical alerts and your patients’ personal health records. It wasn’t all work for us at the conference. As part of our “Step It Up” contest, we issued free pedometers to over 300 of you who stopped by our booth on the first day. The contest’s goal was simple: to let you take advantage of all that walking at the conference and win a fabulous prize just for staying fit. The four contest participants who walked the most steps each won an Aetna Touch iPod. Congratulations to: Lisa Reich with Avera St. Luke’s Clinic Division in Aberdeen, SD; Jacques Wehbe with Caritas Physician Network in Norwood, MA; Terri Clement with Ear, Nose and Throat Specialists of Tulsa, L.L.P. in Tulsa, OK; and Bruce William Thompson with NorthEast Orthopedics, P.A. in Concord, NC. They each walked over 40,000 steps! See you in Denver, CO at next year’s conference. Hispanic calendar features “My Grandmother’s Recipes” n E  ligibility and benefits inquiry n P  recertification request n C  laims submission n C  laim status inquiry Now is the time to order our 2008/2009 Hispanic calendar. The calendar celebrates the importance of food in the Hispanic culture and provides tips about preparing healthy, traditional dishes derived from Hispanic family recipes. Recipes include: Picadillo (a hearty meat dish), Las Lentejas de Mami (my mother’s lentils), Calabacitas con Carne de Cerdo (squash with pork), as well as other main dishes, vegetables and desserts. n E  lectronic remittance advice How to order You can input your office’s actual costs for staff salary, benefits, payroll taxes, postage and envelopes, or let the program estimate them. These calendars are our gift to you. Just visit the Education site on the secure provider website via NaviNet to order your copy (limit three copies per office, while supplies last). December 2008 5 Prescription Medications & Pharmacy Management Fill specialty medications through Aetna Specialty Pharmacy® Beginning January 1, 2009, specialty medications available through Aetna Rx Home Delivery, our mail-order pharmacy, will transition to be filled through Aetna Specialty Pharmacy. Aetna Rx Home Delivery will no longer stock specialty medications, but will continue to provide your Aetna patients with the maintenance medications they need. If you have patients who use Aetna Rx Home Delivery for their specialty medications, those prescriptions with refills remaining will automatically transition to Aetna Specialty Pharmacy, our in-network provider of specialty medications and support for Aetna members. This change will give you and your patients access to enhanced clinical support and special attention. How to order specialty medications Some drugs no longer available Examples of medications that will no longer be available through Aetna Rx Home Delivery include Humira, an injectable most commonly used to treat rheumatoid arthritis; Remicade, a medication given by IV infusion to treat Crohn’s disease; and Synagis, an injectable used to prevent respiratory syncytial virus (RSV). Send all new requests for specialty medications to Aetna Specialty Pharmacy by: n n n n n n P  atients are offered training to help promote safe, consistent therapy. P  rescriptions are proactively refilled and delivered quickly and safely. A  etna Specialty Pharmacy handles purchasing and billing. For more information, visit www.AetnaSpecialtyPharmacy.com or call 1-866-353-1892. P  rinting a Medication Request Form from www.AetnaSpecialtyPharmacy.com. F  axing to 1-866-FAX-ASRX (1-866-329-2779), or M  ailing to Aetna Specialty Pharmacy, 503 Sunport Lane, Orlando, FL 32809. Aetna Specialty Pharmacy benefits n n P  harmacist and nurse support, therapy education, and compliance monitoring is available 24 hours a day, 7 days a week. A  etna Specialty Pharmacy performs multiple quality checks before releasing all orders. Reminder: Use our formulary We annually review and update our commercial (non-Medicare) Preferred Drug List (also called a formulary). The list shows many of the drugs covered by Aetna members’ plans. The 2009 version of this list is available online. We update the formulary regularly, based on the latest medical findings, information from the Food and Drug Administration (FDA) and drug manufacturers, and cost arrangements (which include manufacturer rebates). 6 Aetna OfficeLink Updates While coverage is not limited to medications on the Preferred Drug List, you can help many of your patients lower their costs by prescribing drugs on the list, when appropriate. To learn more, and to view the 2009 Aetna formulary, visit www.aetna.com/formulary. Note: We notified physicians and pharmacies about changes to the 2009 Preferred Drug List in August 2008. Updates to Aetna’s formulary (Commercial and Medicare) We periodically review the Aetna Preferred Drug Lists (formulary) to make sure they meet established criteria for safety, effectiveness and overall value. Recent changes and updates are listed below. To view the complete Aetna Preferred Drug Lists, go to www.aetna.com/formulary. Changes not applicable are marked with an asterisk (*). Drug COMMERCIAL HMO and PPO Step-Therapy (ST) Quantity Limits (QL) Coverage Update PR ST * Coverage Update Precertification (PR) MEDICARE Part D * * * * * * * * * QL FORMULARY ADDITIONS acetic acid-antipyrine-benzocainepolycosanol Preferred (P) Avodart (dutasteride) P X Controlrx pst 1.1% * * * * * Covered (C) divalproex sodium -- delayed release P C eplerenone P C foltabs pak plus dha * * * * C Fusilev (levoleucovorin calcium) inj * * * * Specialty (Sp) galantamine P C Lovaza (was Omacor) (omega-3-acid ethyl esters) P * nisoldipine P NPlate (romiplostim) * Olux-Olux E Complete Pack (clobetasol prop foam/emul foam) P oxycodone er * * * * C Pristiq (desvenlafaxine) P X X X * pruet DHA EC Mis * * * * C Stavzor (valproic acid -- delayed release) * * * * C Renate * * * * C Veramyst (fluticasone fumarate) P X * * Sp X * * C X * * * X * * * X * * * * * * * * FORMULARY REMOVALS Lamictal (lamotrigine) Formulary Excluded (FE) Requip (ropinirole) * * X * * Not Covered (NC) Risperdal (risperidone) * * * * NC X X Sonata (zaleplon) * * * * NC X X NEW DRUGS – Nonpreferred (NP) or FE Alvesco (ciclesonide) FE NC Brevoxyl Kit Complete (benzoyl peroxide creamy wash and benzoyl peroxide bar kit) FE * Duet DHA MIS * * * * NC Gesticare * * * * NC Gesticare Pak DHA * * * * NC Rowasa Kit (mesalamine rectal enema and cleanser wipe kit) FE Stavzor (valproic acid delayed release) FE Zamicet (hydrocodone-APAP soln) * The Preferred Drug, Precertification, Step-Therapy and Quantity Limits lists are subject to change. Visit www.aetna.com/formulary for current information. Many medications on the Aetna commercial and Medicare Preferred Drug Lists are subject to manufacturer rebate arrangements between Aetna and the manufacturer of those medications. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Some programs, such as step-therapy, precertification and quantity limits, are not available in all service areas. Precertification programs do not apply to commercial members in Indiana. Step-therapy does not apply to fully insured commercial members in Indiana and New Jersey. * Commercial California members: In accordance with state law, California HMO members who are receiving coverage for medications added to the formulary exclusions, precertification or step-therapy lists will continue to have those medications covered, for as long as the treating physician continues prescribing them, provided that the drug is appropriately prescribed and is considered safe and effective for treating the enrollee’s medical condition. * * * * * * * * * * * * * NC covered at the same benefits level until their plan’s renewal date. The term “precertification” does not mean a reliable representation of payment of care or services to fully insured HMO and PPO members. This material is provided for informational purposes only and is not intended to direct your treatment decisions. You should exercise your own clinical judgment regarding the appropriate treatment of any individual patient. Commercial Texas members: In accordance with state law, full-risk members in Texas who are receiving coverage for medications that are removed from the Preferred Drug List during the plan year will continue to have those medications December 2008 7 Physician Focus™ Increasing the quality of genetic diagnosis and treatment of breast cancer A message from Troyen A. Brennan, M.D., Aetna Chief Medical Officer Approximately 20 percent of people with breast cancer have tumor types with increased levels of the HER2 protein. To determine the right treatment, it is vital that test results for this tumor marker or protein are accurate. Inaccurate test results can expose patients to the side effects of a drug they may not need, or cause them to miss an opportunity to treat their condition with effective medications. Enhancing awareness: our multi-faceted approach Outreach to physicians Currently, there is no publicly available information source that identifies which labs meet quality standards. Along those lines, we want to educate physicians on the quality issues about testing and encourage them to use high-volume labs that meet guidelines from the American Society for Clinical Oncology/College of American Pathologists (ASCO/CAP). An ASCO/CAP review of HER2 test accuracy found that up to 20 percent of tests may be falsely positive, and up to 10 percent may be falsely negative. With this in mind, we have written to medical and surgical oncologists about the ASCO/CAP guidelines and about the importance of using labs that meet established criteria. Aetna network labs meet testing guidelines Aetna’s contracted labs, Genzyme Genetics, and Quest Diagnostics, meet ASCO/CAP guidelines. Both labs have been conducting HER2 testing since 1998. Genzyme and Aetna are collaborating to encourage compliance with the ASCO/CAP guidelines and advance the quality of genetic laboratory tests. Genzyme’s contract with Aetna includes quality standards that tie reimbursement to specific targets of quality, testing volume and turnaround time. Flexible reimbursement policy for repeat HER2 tests We also cover repeat HER2 test performed at Quest Diagnostics or Genzyme Genetics if the accuracy of the original test result is uncertain and repeat testing will influence treatment decisions. Working with researchers and supporting patients In addition, Aetna is supporting research to understand better how doctors use genetic lab tests to influence their treatment recommendations for women with breast cancer. Specifically, the Aetna Foundation is funding research at the University of California, San Francisco and Brigham and Women’s Hospital in Boston to evaluate whether these patients are offered genetic tests that help physicians individualize patient treatment. The results of this research will help guide the future development of educational interventions and decision-support tools for patients and clinicians. These efforts build on previous work we developed to provide our members with telephone-based cancer genetic counseling (performed through our vendor, Informed Medical Decisions). Building on Aetna’s industry leadership in genetic medicine I am confident that engaging the medical community into our comprehensive approach is a step in the right direction. Directing physicians and members to qualified labs that meet externally validated criteria, developing policies to promote the evidence-based use of genetic services and funding medical research are all critical components. These initiatives, along with offering member support, can help your patients access effective genetic services during each phase of their care. Sincerely, Troyen A. Brennan, M.D. Senior Vice President and Chief Medical Officer 8 Aetna OfficeLink Updates Southwest News Aetna Medicare Advantage plans available in new service areas Beginning January 1, 2009, the following Medicare Advantage plans will expand into these new service areas – Aetna Golden Medicare Plan® (HMO) Aetna Golden Choice™ Plan (PPO) Harris and Montgomery counties, Texas Aetna Medicare OpenSM Plan (PFFS) See new 2009 individual product counties on the secure provider website, noted below. General Aetna Medicare Advantage HMO and PPO plan information n n M  ember ID numbers will start with the letters “ME.” “  Zero copayments” may apply for many covered preventive services. Providers can obtain precertification for Aetna Medicare Advantage HMO and PPO plans online. Providers are required to obtain precertification for certain covered services. You may access Medicare Advantage plan information, including information about our Aetna Golden Medicare Plan (HMO), Aetna Golden Medicare Open Access Plan (also a Medicare Advantage HMO plan), Aetna Golden Choice Plan (PPO) and our Aetna Medicare OpenSM Plan (a Medicare Advantage private fee-for-service plan), online through our secure provider website via NaviNet. Once logged in, under “Plan Central,” select “Aetna Health Plan,” then “Aetna Support Center” from the menu bar on the left, then “Doing Business with Aetna” then “Aetna Benefit Products” then select “Aetna Medicare.” December 2008 9 Southwest News HCA patients must precertify outpatient dialysis services Patients covered by the Hospital Corporation of America (HCA) health plan must precertify outpatient kidney dialysis and other services. Although it is the member’s responsibility to obtain the precertification, we ask you to remind HCA patients about this process so they can receive the highest benefits level. Patients can precertify by calling HCA at 1-800-222-9215 HCA requires precertification for services rendered by non-HCA-affiliated providers. This includes services that may not be on the Aetna precertification list but that are provided by in-network non-HCA-affiliated providers. 10 Aetna OfficeLink Updates Don’t just think outside the box. Think outside the mailbox. Close the mailbox and open your inbox. Get information electronically from Aetna through email instead of in a paper format in your mailbox. Visit https://aetna.providerpreference.com Sign up today for our electronic correspondence option. Aetna OfficeLink Updates December 2008 11 PRSRT STD U.S. POSTAGE PAID PERMIT NO. 12 ENFIELD, CT CPE RS51 151 Farmington Ave. Hartford, CT 06156 Contact us at: OfficeLinkUpdates@aetna.com Please route this publication to: q Office Manager q Business Staff q Front Desk Staff q Medical Records/Medical Assistants q Primary Care Physicians q Specialists q Physician Assistants/Clinical Nurse Specialists q Nurses q Referral and Precertification Stafftaff Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. The Aetna companies that offer, underwrite or administer benefits coverage include Aetna Health Inc., Aetna Health Insurance Company, Aetna Life Insurance Company (Aetna) and Strategic Resource Company. (Aetna) Personal Health Record adds new “tracking” feature We recently updated our Personal Health Record (PHR) tool to include a “Health Tracker” feature. What are Health Trackers? Health Trackers enable patients to more effectively monitor certain key biometrics. These entries can be compared over time to show progress. Health Trackers are available for: n Asthma peak flow n Blood glucose level n Blood pressure n Creatinine level n HDL cholesterol n Hemoglobin A1C n LDL cholesterol n n Triglyceride level n Weight/BMI The information that populates the Health Trackers is entered into the PHR either automatically from information made available to Aetna or self-reported by the patient. Detailed information included in these Health Trackers may help monitor health conditions and keep the patient more closely engaged with his/her health care. Total cholesterol Remind patients about PHR You must be registered with NaviNet to view your patients’ PHRs, and your patients must grant you access to view their PHRs. Talk to your patients about the benefits of using our PHR. The information and/or programs described in this newsletter may not necessarily apply to all services in this region. Please contact your Aetna network representative to find out what is available in your local network. Application of copayments and/or coinsurance may vary by plan design. This newsletter is provided solely for your information and is not intended as legal advice. If you have any questions concerning the application or interpretation of any law mentioned in this newsletter, please contact your attorney. 23.22.807.1-SW (12/08) ©2008 Aetna Inc.