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Mid-Atlantic Region - page 10 / 12





10 / 12

Mid-Atlantic News

Do not collect copays from d

ual eligible members

Dual eligible members are not responsible for paying copays, deductibles or coinsurance for covered services owed under the Aetna Golden Medicare Dual Advantage Plan. However, a review of our records shows that some provider offices are billing our dual eligible members for these cost-sharing amounts in error.

The Aetna Golden Medicare Dual Advantage Plan is a Medicare Advantage Special Needs Plan (SNP) that is solely offered to Medicare beneficiaries who are eligible to enroll in both Medicare and a state Medicaid plan. You can check a patient’s Medicaid enrollment status by contacting the state Medicaid program.

Please note: If you provide covered services to a dual eligible member, you should bill the state Medicaid program for the applicable cost sharing.

We’ve updated our SNP ID cards with the words “Request Medicaid Card” to help your office staff more easily identify dual eligible members. (See sample SNP ID card.)

MedSolutions to handle outpatient diagnostic imaging precert

Beginning November 1, 2009, MedSolutions will assume responsibility for review of medical appropriateness and preauthorization for all high-tech outpatient diagnostic imaging procedures. This change applies for all Aetna patients in the areas noted below.

Delaware, Pennsylvania (SE PA, berks, Carbon and Monroe counties)

and Southern New Jersey MRI/MRA PET scan Nuclear medicine Cardiac CTA n n n n

Maryland, Washington, DC, Northern Virginia and HMO-based

Continue to submit precertification requests to NIA or CareCore as you currently do through October 31, 2009. Precertification requests received and authorized by NIA or CareCore through this date will remain as valid authorizations. Note: The Aetna Medicare OpenSM (PFFS) and Traditional Choice® plans are excluded from the preauthorization process.

How to request precertification Submit precertification requests through MedSolutions’ secure website at www.MedSolutionsonline.com, by phone at 1-888-693-3211 or by fax at 1-888-693-3210.

plans only in richmond, VA CT Scan/Cardiac CTA Nuclear Cardiology MRI/MRA PET scan n n n n

learn more View Aetna’s Participating Provider Precertification List at www.aetna.com. Select “Health Care Professionals” then “Medical.”


Aetna Officelink Updates

You can learn more about this plan via a recorded webinar by going to www.AetnaEducation.com and searching for the Aetna Golden Medicare Dual Advantage Plan recorded webinar.

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