For Providers

Aetna Better Health of Florida takes great pride in our network of physicians and related professionals who serve our members with the highest level of quality care and service. We’re absolutely committed to making sure our providers receive the best possible and latest information, technology and tools available to ensure their success and their ability to provide for clients.

We will arrange for care and services by specialists, hospitals, and providers including member engagement, which includes outreach and education functions, grievances and appeals.  

The goals of Aetna Better Health of Florida’s plan are to:  

  • Create a person-centered care management approach to improve the quality of care members receive  
  • Comprehensively manage benefits across the continuum of care, including social and community services  
  • Integrate services for all physical, behavioral, long-term care, and social needs  

We focus on operational excellence, constantly striving to eliminate redundancy and streamline processes for the benefit and value of all of our partners.

Our ability to serve our members well is dependent upon the quality of our provider network. Our providers are the cornerstone of our service delivery approach. By joining our network, you are helping us achieve our goal of providing our members with access to high quality health care services.  

Together we can improve health care quality

At Aetna Better Health of Florida, we value our provider partners. We want to work with you to provide timely, safe and effective health care to our members. We are committed to making sure our providers receive the best and latest information, technology and tools available to ensure their success and their ability to provide for our members.

Good communication among our providers and our plan administrators is key to the delivery of quality health care services to our members. Please don’t hesitate to contact us any time with any questions you have.

On this site, you’ll also find:

  • Information about clinical practices
  • The forms and resources you need
  • The latest provider news and notices

We're here to help. You can contact your provider relations representative for help. He or she can schedule a visit to answer questions about:

  • Enrollment
  • Credentialing
  • Secure web portal navigation

We hope you find the information on this site to be useful. Should you have any questions or concerns, contact us directly at:
Medicaid: 18004415501 
Comprehensive Long Term Care: 18446457371
Florida Healthy Kids: 18445285815
Via email at: FLMedicaidProviderRelations@aetna.com

What is Continuity Of Care?

COC requirements ensure that when enrollees transition from one health plan to another, one service provider to another, or one service delivery system to another (i.e., fee-for-service to managed care), their services continue seamlessly throughout their transition.

Aetna Better Health of Florida Continuity of Care Responsibilities

Aetna Better Health of Florida (ABHFL) will be responsible for coordination of care (COC) for new members transitioning into the Plan. In the event a new member is receiving a prior authorized, ongoing course of treatment for a covered service with any provider, ABHFL will be responsible for the costs of continuation of such course of treatment without regard to whether such services are being provided by participating or non-participating providers.

For Medicaid and Florida Healthy Kids members, Aetna Better Health will honor documented authorization of ongoing covered services for a period of sixty (60) days after the effective date of enrollment.

  • The Plan will provide approval for continuation of covered services until the member’s PCP or behavioral health provider (as applicable to medical or behavioral health services, respectively) reviews the member’s treatment plan, which shall be no more than sixty (60) calendar days after the effective date of enrollment. Providers with transitioning members to cooperate in all respects with providers of other managed care plans to assure maximum health outcomes for members.

There are exceptions to the 60 days. The following services may extend beyond the sixty (60) day continuity of care period. Please contact Aetna’s clinical team for an authorization. Member can continue the entire course of treatment with their current provider as described below:

  • Prenatal and postpartum care –  Continue to pay for services provided by a pregnant woman’s current provider for the entire course of her pregnancy, including the completion of her postpartum care (six (6) weeks after birth), regardless of whether the provider is in the Managed Care Plan’s network.
  • Transplant services (through the first-year post-transplant) –  Continue to pay for services provided by the current provider for one (1) year post-transplant, regardless of whether the provider is in the Managed Care Plan’s network.
  • Oncology (Radiation and/or Chemotherapy services for the current round of treatment) – Continue to pay for services provided by the current provider for the duration of the current round of treatment, regardless of whether the provider is in the Managed Care Plan’s network
  • Hepatitis C Treatment – Full course of therapy for Hepatitis C treatment drugs.
  • Long-Term Care (LTC) - For Long-Term Care, the enrollee receives a comprehensive assessment, a plan of care is developed, and services are authorized and arranged as required to address the LTC needs of the enrollee.

Providers will be paid. Providers should continue providing any services that were previously authorized, regardless of whether the provider is participating in the Aetna Better Health’s network. Aetna Better Health will pay for previously authorized services for up to 60 days after the member’s enrollment. Claims will be paid at 100% of the Medicaid fee schedule unless a separate rate is negotiated. 

Prior Authorization Form (all line of business)

Resources:

The Agency of Health Care Administration (AHCA) Continuity of Care (COC) Provisions

 

 

Florida Medicaid Health Care Alert 
December 07, 2018

Statewide Medicaid Managed Care: Continuity of Care Provisions

The Agency for Health Care Administration (Agency) contracts with Medicaid health and dental plans to provide services to health plan enrollees in the Statewide Medicaid Managed Care (SMMC) program. The Agency recently entered into new contracts with health and dental plans. As part of those contracts, the Agency achieved program changes that greatly benefit enrollees and providers.

The Agency will transition to the new contracts through a regional phased roll-out. The first regional roll-out occurred on Saturday, December 1, 2018. Roll-out for phase two will occur Tuesday, January 1, 2018.

Health and dental plans are required to ensure continuity of care (COC) during the transition period for Medicaid recipients enrolled in the SMMC program.  COC requirements ensure that when enrollees transition from one health plan to another, one service provider to another, or one service delivery system to another (i.e., fee-for-service to managed care), their services continue seamlessly throughout their transition.  The Agency has instituted the following COC provisions:

  • Health care providers should not cancel appointments with current patients. Health plans must honor any ongoing treatment that was authorized prior to the recipient’s enrollment into the plan for up to 60 days after the roll-out date in each region.
  • Providers will be paid. Providers should continue providing any services that were previously authorized, regardless of whether the provider is participating in the plan’s network. Plans must pay for previously authorized services for up to 60 days after the roll-out date in each region, and must pay providers at the rate previously received for up to 30 days.
  • Providers will be paid promptly.  During the continuity of care period, plans are required to follow all timely claims payment contractual requirements.  The Agency will monitor complaints to ensure that any issues with delays in payment are resolved.
  • Prescriptions will be honored. Plans must allow recipients to continue to receive their prescriptions through their current provider, for up to 60 days after the roll-out date in each region, until their prescriptions can be transferred to a provider in the plan’s network.

More information about COC provisions can be referenced on the COC program highlight document, which is posted on the Agency’s website at www.ahca.myflorida.com/smmc. Once on the page, click Program Changes, then the Outreach and Presentations link.

Aetna Better Health of Florida Rural Health Clinic Grant

Aetna Better Health of Florida’s (ABHFL) Rural Health Clinic Grant (RHC) funding is to assist providers in covering fees or consultations needed in order to adopt or expand the use of electronic health records system, connectivity to the state Health Information Exchange and other community providers. Any funds issued by Aetna Better Health of Florida will be used exclusively to promote enhancements of EMR system.

If you are rural health clinic and interested in this grant, please complete the following Rural Health Clinic Grant Electronic Health Records (EHR) questionnaire. 

Please submit your completed questionnaire via email to the Provider Relations Department at FLMedicaidProviderRelations@aetna.com.