Aetna Better Health Provider Contract Agreements
If you would like to participate in the Aetna Better Health HUSKY and Charter Oak
provider networks in Connecticut, please print two (2) copies of the applicable
Provider Contract Agreement below and mail to:
Aetna Better Health, Inc.
Network Development
Attention: Lanaya Sandberg
151 Farmington Ave. RS46
Hartford, CT 06156
To ensure expedited processing of the Provider Contract Agreement, please ensure
that you fully complete and include the following in your submission:
- Indicate applicable provider name on page 1;
- Indicate address to mail Notices to in Section 9, Miscellaneous;
- Complete the signature page in its entirety;
- Complete the Service and Billing Location Form, which is the last page of all Provider
Contract Agreements;
- For PCP and Specialist Groups, an Individual Provider Addendum must be completed
for every provider (DO, MD, APRN, PA, etc.) in the group; and
- A copy of the provider’s
W-9 form.
For questions regarding the Provider Contract Agreements, please contact Lanaya
Sandberg, Contract Negotiator for Aetna Better Health at
SandbergL@aetna.com.
- Primary Care
Physician Agreement
This Provider Contract Agreement is for any physician who acts as a primary care
provider, which includes family practice, internal medicine, pediatrics, and OB/GYNs.
- Specialist
Physician Agreement
This Provider Contract Agreement is for any specialist physician, which includes
urology, orthopedics, oncology, and endocrinology.
-
Physician Group Agreement
This Provider Contract Agreement is for any primary care physician or specialist
physician group. An Individual Provider Addendum must be submitted for each
provider (DO, MD, APRN, PA, etc.) in the group.
- Facility
Services Agreement
This Provider Contract Agreement is for any facility that is not a hospital and
bills on a UB-04 claim form, which includes radiology centers, federally qualified
health centers (FQHCs), and skilled nursing facilities.
- Ancillary Services Agreement
This Provider Contract Agreement is for any supplemental services rendered by a
non-MD provider, which includes physical therapy, podiatry, and chiropractics.
Laboratory and Durable Medical Equipment providers who are interested in participating
in our provider network please contact Lanaya Sandberg at the email address above
for a copy of an agreement.
Note these changes to your
provider contract
Aetna Better Health, Inc. has incorporated three changes into our provider contracts,
which are listed below. There are two additions, as well as a revision to the definition
of “Medically Necessary or Medical Necessity.” We ask that you keep these changes
with your contract documents.
|
1.
|
The Company may not prohibit, or otherwise restrict, a health care professional
acting within the lawful scope of practice, from advising or advocating on behalf
of a Member who is his or her patient, for the Member's health status, medical care,
or treatment options, including any alternative treatment that may be self-administered.
|
|
2.
|
If your provider agreement with Aetna Better Health, Inc. to provide services to
members of the HUSKY A, HUSKY B, and/or Charter Oak programs (the "Agreement") has
been executed by an entity other than Aetna Better Health Inc., a Connecticut corporation,
the Agreement is hereby deemed to have been assigned to and executed by Aetna Better
Health Inc., a Connecticut corporation, effective as of the later of (i) June 25,
2008, or (ii) the Effective Date of the Agreement.
|
|
3.
|
Definitions: Medically Necessary or Medical Necessity. Health services required
to prevent, identify, diagnose, treat, rehabilitate or ameliorate an individual's
medical condition, including mental illness, or its effects, in order to attain
or maintain the individual's achievable health and independent functioning provided
such services are: (1) Consistent with generally-accepted standards of medical practice
that are defined as standards that are based on (A) credible scientific evidence
published in peer-reviewed medical literature that is generally recognized by the
relevant medical community, (B) recommendations of a physician-specialty society,
(C) the views of physicians practicing in relevant clinical areas, and (D) any other
relevant factors; (2) clinically appropriate in terms of type, frequency, timing,
site, extent and duration and considered effective for the individual's illness,
injury or disease; (3) not primarily for the convenience of the individual, the
individual's health care provider or other health care providers; (4) not more costly
than an alternative service or sequence of services at least as likely to produce
equivalent therapeutic or diagnostic results as to the diagnosis or treatment of
the individual's illness, injury or disease; and (5) based on an assessment of the
individual and his or her medical condition.
|
If you have any questions contact:
- Karen Libeson, Network Manager, at 1-860-808-2644
- Lanaya Sandberg, Contract Negotiator, at 1-860-808-2646
|