By providing us with your email address, you agree to receive email communications from Aetna until you opt out of further emails. It provides benefits to members who qualify for Medicare and who receive full Medicaid benefits and/or assistance with Medicare premiums or Medicare Parts A & B cost sharing through one of the Medicare Savings Program (MSP) categories. You are now being directed to CVS caremark site. Links to various non-Aetna sites are provided for your convenience only. To get started: 1. A DSNP is a special type of Aetna Medicare Advantage Prescription Drug (MAPD) plan. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. You can narrow your Aetna provider search by filtering provider characteristics, geographic location and best matched . Unlisted, unspecified and nonspecific codes should be avoided. To search for a dentist, please choose a state, your plan and enter the zip code under the Enter Your Geographic Area section. 2023 DentalPlans.com, Inc. All Rights Reserved. Primary care physicians, specialists, mental health providers and family planning providers, Hospitals, long-term care facilities and skilled nursing facilities for rehabilitation, mental health facilities, Federally Qualified Health Centers and Rural Health Clinics, Adult day services, assisted living, home-delivered meals, home health agencies and home medical equipment providers. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. We update our provider directory nightly. These directories of Louisianas network providers includes: Enter provider or facility name or select a specialty. Find an Aetna Dentist in Your Area | Aetna Dentists Near Me Helping you find the right doctor for you. Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. The member's benefit plan determines coverage. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Note not all Aetna dental plans and offers available in all markets. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). Enter a zip code to search for dental care professionals in your area. Aetna Better Health Dental Links to various non-Aetna sites are provided for your convenience only. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. Plan from an employer Aetna Medicare plan, Individual health plan Aetna Medicaid plan Dr. Shannitta Bridgers is a pediatric dentist at Highland Pediatric Dental in Fayetteville, SC. Join our team. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Do you want to continue? If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. All provider information contained on this website is subject to change. Health Insurance Plans | Aetna CPT only copyright 2015 American Medical Association. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Please review the plan benefit coverage documentation under the link below. Treating providers are solely responsible for medical advice and treatment of members. CPT is a registered trademark of the American Medical Association. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. Each main plan type has more than one subtype. Please note that providers listed in this directory may perform services that are not covered by your health plan. The AMA is a third party beneficiary to this Agreement. The online provider directory is updateddaily. What's covered? All services deemed "never effective" are excluded from coverage. As a LIBERTY enrollee (including enrollees with disabilities), you have full and equal access to covered services as required under the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973. *Required Selections. list of CPT or HCPCS codes to only those requiring PA, please check the box labelled Include only CPT or HCPCS codes where PA is required?. Aetna Smart Compare is a designation we give to doctors in our network who have proven time and again that they provide high-quality, effective care. CMS requires providers to take the Model of Care training course (PDF). Enter your location by address, city or zip code. Experience and expertise to help our customers and members navigate the complex global health care landscape. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. logo Aethna Better Health of West Virginia. They also provide cosmetic services such as overlays and whitening treatments. Looking for a local dentist? The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). All rights reserved. Providers may not balance bill members who do not have cost-share responsibility (including QMB-only). If you wish to make a standing request to receive all materials in a language other than English or in an alternate format, you can call Aetna Better Health ofLouisiana Member Services at 1-855-242-0802, TTY 711, 24 hours a day, 7 days a week. Please check before scheduling an appointment to make sure the provider is participating in the program. Find a Dentist. Links to various non-Aetna sites are provided for your convenience only. Learn more about our dental advantages. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Select a Plan * Select a Plan: 2. You are now being directed to CVS Caremark site. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. Neither Aetna Inc. nor its subsidiaries are Guardian affiliates. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Find a Doctor :: State of Illinois - Aetna Members must choose a PCP* to guide their treatment and coordinate all specialist care which all takes place in a quality network to keep costs in check. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Tools and resources that create a more personalized and convenient . Vision Provider Locator #2020 . Category: Health Detail Health. Check your participation status using the provider search tool. 2022 DSNP information - Aetna Dental Providers: Register now for AetnaDental.com Medical Providers: Register for Aetna's Provider portal on Availity: Virginia State Dental Plans | Member Information - DentaQuest VisitVision Provider Searchto view your vision providers. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Geographic Search. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). You'll find these doctors with the label "Quality Care," "Effective Care" or both in your search. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. New and revised codes are added to the CPBs as they are updated. This list is updated nightly. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. When billing, you must use the most appropriate code as of the effective date of the submission. Treating providers are solely responsible for medical advice and treatment of members. Your plan may only provide benefits if you obtain a referral from your General Dentist prior to receiving treatment from a Specialist. Filter Type: All Symptom Treatment Nutrition Dental Services Aetna Medicaid New Jersey . DocFind, Aetna's online participating provider directory, allows you to locate physicians and other health care providers such as dentists, optometrists, hospitals and pharmacies. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Reprinted with permission. Were expanding our DSNP program into more markets for 2022. In case of a conflict between your plan documents and this information, the plan documents will govern. The member's benefit plan determines coverage. Aetna dental plans are not considered to be qualified health plans under the Affordable Care Act. Visit the secure website, available through www.aetna.com, for more information. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Besides treating dental conditions, she educates her young patients on the importance of proper dental health and dispenses practical advice on maintaining dental hygiene. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. NJ FIDE-SNP members will have one member ID card for both Medicare and Medicaid. The DSNP network is in limited counties. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. Each main plan type has more than one subtype. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. Do you want to continue? Each plan has its own provider network. * Enter Provider ID : * Enter NPI : *Provider Type : Select a Provider Type Medical (Includes Behavioral Health) Dental Facilities. Family planning, Emergent and Urgent Care services do not require PA. Aetna has one of the nation's largest dental networks, with more than 200,000 participating dental practices, making it easy to find a great dentist or specialist near you. Neither Aetna Inc. nor its subsidiaries are Guardian affiliates. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Just call Member Services at 1-866-329-4701 (TTY: 711) to learn more about these services. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Click here for additional information regarding benefit coverage. Prosthodontists: restore damaged teeth or replace missing ones, with procedures that include dental implants, bridges, crowns and dentures.
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