Notices

Aetna Better Health of New Jersey publishes provider notices containing up-to-the-minute information you may need to know from our regulators, new coding/claims processing rules, or any other new plan information. Our goal is to keep you as well informed about our plan as possible. Be sure to check this page often.

What's new

Provider notices

Subject: Provider Notification: Unlisted Code

Date: August 8, 2017


 

Effective September 15, 2017, Aetna Better Health of New Jersey will change the way unlisted and non-specific CPT and HCPCS codes are reviewed and paid.

With a few exceptions listed below, these codes will no longer be managed through the prior authorization process. They will be managed with Medical Records at the time of claim submission. That is, records supporting the use of these codes must be submitted with the claim. These claims will pend to our AMA Edit Team who will review for:

Codes not included in the process change are:

Code(s)

Process

41899 – General Anesthesia for dental procedures

Prior Authorization

E1399 and K0108 – wheelchair components and services

Prior Authorization

90999 – unlisted dialysis procedure

Prior Authorization with dialysis services

Unlisted J code

Prior Authorization

 

If records are not submitted with any claim including one of the codes listed below, the claim will be denied for lack of documentation. You may resubmit the claim with required supporting records.

 

Please refer to the list for the codes covered by this process.

Subject: FluMist No Longer Covered
Date: September 1, 2016


Aetna Better Health of New Jersey covers all vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP). ACIP regularly reviews all formulations of vaccines and updates its list of recommended vaccines. In previous years, the list included a live attenuated Influenza vaccine (LAIV) for individuals aged 19-49 in a nasal spray formulation (Flumist).  Recently the ACIP determined that the current LAIV should not be used for the 2016-2017 Influenza season. 

As a result of the decision by ACIP, Aetna Better Health of New Jersey will no longer cover LAIV for prevention of influenza for the 2016-2017 Influenza season.  ACIP continues to recommend annual flu vaccination with either the inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) for everyone 6 months and older.  Injectable Seasonal Influenza Vaccines (Trivalent and Quadrivalent) and Intradermal Influenza Vaccine (Short Needle) will continue to be covered during the current Flu Season of August 1, 2016 –April 30, 2017. These vaccines are available through a participating pharmacy. View the CDC Newsroom Media Statement

Subject: Fluoride varnish
Date: Oct. 21, 2015


Aetna Better Health on New Jersey encourages medical providers to apply fluoride varnish to children’s teeth, perform dental assessments and promote routine oral heath visits for Aetna’s young members.

PROGRAM GUIDELINES:

  • Participating pediatricians, nurse practitioners and physician assistants who have completed an online training curriculum or who have received training from an already trained provider can be reimbursed for the application of fluoride varnish.
  • Pediatricians will be reimbursed $15 for each varnish application every three months on members up to age five.
  • Enter CPT code 99188 and ICD-10 diagnosis code Z00.12X or Z76.2 on the claim form when billing Aetna. Only trained providers will be reimbursed.
  • Online training can be completed at www.smilesforlifeoralhealth.org/. Click course 6: Caries Risk Assessment, Fluoride Counseling on the right side column. One provider per facility needs to complete the online curriculum and can then train their colleagues.
  • Providers who have completed the training must sign a form attesting they have completed the curriculum. The form is on our website. Please FAX the form to Joseph Maggio 1-860-607-8842.