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Announcements and notices
New Review Process for DRG Claims
We want to inform you about an upcoming new process that will affect Aetna Assure Premier Plus. For admission dates on or after February 1, 2024, we will perform prepayment coding reviews for diagnosis-related group (DRG) claims. As always, we want to ensure the claims correctly show the services you provide to our members.
Helpful tips to ensure you get paid correctly
To make sure we review your claims quickly and accurately, please give us the necessary clinical information up front. After we get your claim, we will:
- Review DRG facility claims based on case history
- Check to ensure the ICD diagnosis and procedure codes show the appropriate DRG was billed
As always, do not hesitate to contact your Aetna Assure Premier Plus Provider Relations Representative with any questions or comments.
Thanks for all you do!
Sincerely,
Aetna Assure Premier Plus
January 9, 2023
Clinical Payment and Coding 2024 Update (PDF)
November 29, 2023
November 20, 2023
October 6, 2023
October 4, 2023
Lab NCDs and Precertification Optimization (PDF)
The State of New Jersey's Electronic Visit Verification team has scheduled two training sessions related to phase 2 implementation for cohorts 1 and 2 for home health providers
August 24, 2023 3:00-4:00 PM Webinar: EVV Phase 2 Provider Training Session 1
You are invited to a Zoom webinar.
When: Aug 24, 2023 03:00 PM Eastern Time (US and Canada)
Topic: EVV | DMAHS Phase 2 Provider Training Session 1 of 2
Register in advance for this webinar:
https://us02web.zoom.us/webinar/register/WN_pGY17SjESKKl4maBJZuTlw
or
September 14, 2023 3:00-4:00 PM Webinar: EVV Phase 2 Provider Training Session 2
You are invited to a Zoom webinar.
When: Sep 14, 2023 03:00 PM Eastern Time (US and Canada)
Topic: EVV | DMAHS Phase 2 Provider Training Session 2 of 2
Register in advance for this webinar:
https://us02web.zoom.us/webinar/register/WN__4RT7lIMShuWJh6mlHVhvw
After registering, you will receive a confirmation email containing information about joining the webinar.
July 25, 2023 - Availity Promotional Flyer (PDF)
July 18, 2023 - Precertification Optimization July Update (PDF)
June 5, 2023 - Covid Non-Covered Services (PDF)
May 10, 2023 - COVID-19 PHE Unwinding Liberalizations (PDF)
April 6, 2023 - Precertification Optimization 06/30/2023 (PDF)
March 24, 2023 - New Fraud, Waste, and Abuse Penalties and Reporting (PDF)
March 1, 2023 - EFT and ERA Program Update (PDF)
February 2, 2023 - Clinical Payment, Coding and Policy Changes, eff. 3/1/2023 (PDF)
January 4, 2023 - Prior Authorization Waiver Notification (PDF)
November 11, 2022 - Hospital Acquired Conditions Notice (PDF)
October 1, 2022 - Address Changes (PDF)
August 30, 2022 - Precertification Optimization removal (PDF)
August 17, 2022 - NJ Assistance Request on the Credentialing Performance Committee (PDF)
July 15, 2022 - Precertification Optimization Notice 3rd Update (PDF)
June 7, 2022 - Duals Precertification Optimization Add (PDF)
May 20, 2022 - Provider Onboarding and Go-Live dates for Phase 2 (PDF)
April 27, 2022 -COE Provider notification - Precertification Optimization (PDF)
October 22, 2021 PCA Agency EVV Refresher Training (PDF) and training video
The New Jersey Fiscal Year 2022 budget has increased several rates for these services. Here are the state-mandated reimbursement rates:
- Medical day care (adult day health services): $86.10 per diem
- Personal care assistant (PCA): $22.00 per hour
- Assisted living facilities: $87.00 per day
- Comprehensive personal care homes: $77.00 per day
- Assisted living programs: $67.00 per day
We’ll update our payment system to include the new rates and retroactively adjust any impacted claim payments for dates of service on or after July 1, 2021. We’ll also reprocess based on claims already submitted, so you don’t need to submit claims.
June 2021 EVV Billing Training for Aetna Better Health of New Jersey and Aetna Assure Premier Plus (HMO D-SNP)
- June 14, 2021 Training Video
- June 14, 2021 Training Presentation
- June 10, 2021 Training Presentation
EVV Billing Training for Aetna Better Health and Aetna Assure Premier Plus (HMO D-SNP) PCA providers and EVV technical contacts
May 22, 2021, Aetna Better Health of New Jersey and Aetna Assure Premier Plus (HMO D-SNP) provided PCA Agency training-billing through HHAx and Readiness for July 1, 2021, Compliance date. Training PDF and Video.
The next session will be held June 10, 2021 from 1:00 pm to 2:30 pm. A calendar invite has been sent to all PCA providers. If you need additional information, please email Joseph Manger, ABHNJ COO at: MangerJ@Aetna.com
Upgrades to the Provider Portal
Prior Authorization Fax Number Update
CMS NEWS: CMS Takes Action to Protect Integrity of COVID-19 Testing
We publish a provider newsletter several times a year with news you need to know. Check back soon for updates and the latest issues.
Winter 2023 - 2024 newsletter (PDF)