Transcription
Aetna Better HealthWebinar SeriesPrior AuthorizationsProvider ExperienceNetwork Relations TeamKim Heggenstaller, Network Relations ConsultantMichele James, Manager, Clinical Health Services andPrior AuthorizationsKelsey Sahi, Learning Content Developer & Facilitator,Client Engagement ServicesAugust 2021
Housekeeping All lines will be muted to reduce background noise Use the Q & A to submit any questions to ALL PANELISTS The presentation will be available on our website under Past ProviderEducation Webinars within a week and here is the a/providers/education2 2019 Aetna Inc.
“As a team, we arecommitted to supportingour providers and workingtogether toward positiveoutcomes for your patient,our member.— YOUR PROVIDER EXPERIENCE TEAM —3 2019 Aetna Inc.
Experience:La Shawn has been with Aetna for 3 years, but her healthcare background spansacross 30 years. Her areas of expertise include Client Services, PhysicianReimbursement, Provider Relations and Organizational Development. La Shawn is anatural leader experienced in client acquisition and relationship building withphysicians and senior level hospital administrators.Territory:Abington, AbsoluteCare, Ampersand, CHOP, Drexel, Einstein, Jefferson, Tower HealthMore about La Shawn:La Shawn loves to be outdoors, visiting parks, horticultural centers and other placesthat appeal to her aesthetic appreciation of nature. She also enjoys reading,journaling and spending time with family, friends and colleagues.La Shawn BaileyNetwork Relations ManagerEmail: BaileyL2@aetna.comPhone: 267-993-4526
Prior Authorizations5 2019 Aetna Inc.
Agenda Prior Authorization Process Prior Authorization Checklist Availity training – Prior Authorizations eviCore Prior Authorizations Questions6 2019 Aetna Inc.
Prior Authorization Process Flow Providers should submit all Prior Authorization requests through the Availity platform, to becovered later in this presentation The requests will be routed to the ABHPA Prior Authorization department for review anddetermination The Prior Authorization determination will be available within the Availity platform
Forms on ABHPA Website
Prior AuthorizationRequest /ASSETS/PDF/PROVIDER/PACKET/PRIORAUTHFORM-NDCCODE PA%2020102.PDF9 2019 Aetna Inc.
Prior Authorization TION%20CHECKLIST%2020101.PDF10 2019 Aetna Inc.
Prior AuthorizationContact InformationPhone: 1-866-638-1232Fax: 1-877-363-8120
Provider Portal; Authorization Tips If you are submitting an electronic auth request but the request is not completed correctlythis will result in your request not processing in the Availity system and will not reach theUtilization Management Team for a decision review If your request is not completed correctly, the ABH staff are not permitted to correct yourrequest. If this happens the ABH staff will reach out to you to inform you of the situation andrequest that you resubmit the request correctly or cancel your request The clock will not start on a decision until the Provider correctly submits the authorizationrequest Availity is only intended as an initial authorization request tool Auth review status and claims payment information can be accessed through Availity ABH Prior Authorization Checklist12 2019 Aetna Inc.
Availity Prior ED BY KELSEY SAHI13 2019 Aetna Inc.
eviCore Prior Authorizations14 2019 Aetna Inc.
eviCore Prior AuthorizationsRadiology (x-ray) servicesAngiograms, angioplasty, embolization, bonedensitometry, MRI/MRA, PET scans, CT scans,discogram, myelogram, electromyography, otherdiagnostic radiology procedures and routine xrays, including portable, are covered. Refer to theprior authorization grid by accessing our secureprovider portal at AetnaBetterHealth.com/PALog into evicore.com/pages/providerlogin.aspxPhone: 1-888-693-3211Fax an eviCore health care request form (availableonline) to 1-844-82AETNA
Questions?16 2019 Aetna Inc.
Provider Relations Territory Information17 2019 Aetna Inc.
Provider Relations Territory humberlandArmstrongIndianaAlleghenyCambria PhiladelphiaDelawareSherry FlanneryMelinda RoachKim HeggenstallerVacantJacelyn CressmanKimberly YoungVacantMichelle Bogardflannerys1@aetna.com18 2019 Aetna chael Quinnquinnm2@aetna.comVacantKari Heggsheggsk@aetna.comTeresa Washington-FQHC’swwasingtont5@aetna.comAetna Better Health of Pennsylvania
Large Group & Hospital Assignments19Provider GroupRepresentativeProvider GroupRepresentativeAdvocare PediatricsKari HeggsNemoursJacelyn CressmanAllegheny Health NetworkvacantPenn State/Hershey HealthMindy RoachChildren’s Hospital of Phila.La Shawn BaileyPhoenix Rehab & Health Services, Inc.Michael QuinnCoordinated HealthJacelyn CressmanCrozer KeystoneKari HeggsQuest DiagnosticsKari HeggsCVS MinuteClinicKari HeggsSt. Christopher’sLa Shawn BaileyDetweiler Family MedicineKari HeggsSt. Mary Medical CenterKari HeggsDrexel MedicineLa Shawn BaileyTower HealthLa Shawn BaileyEinstein Health NetworkLa Shawn BaileyUPMC ColeMelinda RoachFQHC’sTeresa WashingtonUPMC PinnacleMichelle BogardGeisingerKim HeggenstallerUPMC SusquehannaMelinda RoachJefferson HealthLa Shawn BaileyUPMC – Western PAMelinda RoachLehigh Valley Health NetworkJaclyn CressmanWellSpan HealthMichelle BogardTrinity (Mercy) HealthKari HeggsWest Virginia UniversitySherrie Flannery 2019 Aetna Inc.
Satisfaction SurveyThe annual ABH of PA provider satisfactionsurvey has begun.If you have been randomly selected to take thesurvey, please take a moment to share yourfeedback.We would appreciate your participation.
Spring/Summer lvania/assets/pdf/provider/notices/2021 provider newsletter spring summer.pdfQuick Reference nce%20Guide%2020091.pdfProvider Experience Education vania/providers/educationNetwork Relations Consultant Territory itory%20MapUA.pdf
22 2019 Aetna Inc.
Aetna Better Health Webinar Series Prior Authorizations Provider Experience . La Shawn has been with Aetna for 3 years, but her healthcare background spans across 30 years. Her areas of expertise include Client Services, Physician . Penn State/Hershey Health Mindy Roach Phoenix Rehab & Health Services, Inc. Michael Quinn
