Please be sure to add a 1 before your mobile number, ex: 19876543210. Aetna handles premium payments throughInstaMed, a trusted payment service. The information you will be accessing is provided by another organization or vendor. The AMA is a third party beneficiary to this Agreement. This information is neither an offer of coverage nor medical advice. You are now being directed to the CVS Health site. All Rights Reserved. This information helps us provide information tailored to your Medicare eligibility, which is based on age. Some plans include an out-of-network benefit. No fee schedules, basic unit, relative values or related listings are included in CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Members should discuss any matters related to their coverage or condition with their treating provider. *MEMBER ID 123456789012 *FIRST NAME MIDDLE INITIAL Plan features and availability may vary by service area. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Check your Evidence of Coverage for a list of services that require prior authorization. This search will use the five-tier subtype. The path to healthy starts here. You are now being directed to CVS Caremark site. If you do not intend to leave our site, close this message. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. An IPA/PHO is an association of independent providers. Want to help transform health care? Medicare coverage for the whole you body, mind and spirit, Discover coverage that takes a total approach to health, See how we help you get the right resources and care, Take full advantage of everything your plan offers you. Aetna handles premium payments through InstaMed, a trusted payment service. Youll have to choose a primary care physician (PCP). CVS Health provides the info on the next page. 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. To begin a provider search, click on the 'Enter DocFind' button below and follow the screen prompts. PEBTF - Active Members Information: HMO If you do not intend to leave our site, close this message. DocFind, Aetna's online participating provider directory, allows you to locate physicians and other health care providers such as dentists, optometrists, hospitals and pharmacies. You can also visit us at ${website}. Pennsylvania Employees Benefit Trust Fund (PEBTF) | Aetna Medicare PDF NEW EMPLOYEE BENEFITS SUMMARY BOOKLET - Pennsylvania Attorney General The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. Aetna Choice PPO Provider Directory; Aetna Choice PPO Provider Search Instructions; Aetna Custom HMO; Aetna Custom HMO Provider Directory; . Aetna Better Health of pennsylvania is not responsible or liable for non-Aetna Better Health content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. We promote plans with higher exam . Are you looking forlab testing? To search for an Aetna provider that participates in the PEBTF plan: Click on the above link At the top of the page select one of the following: Already a member? Members should discuss any matters related to their coverage or condition with their treating provider. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Our pharmacy network offers national chains as well as local options for your prescription drugs. Credentials Verifications Organizations for credentialing certification. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. CPT is a registered trademark of the American Medical Association. The Aetna provider portal on Availity helps you spend less time on administration so you can focus more on patient care. 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. If yours does and you decide to receive covered services from an out-of-network provider, ask the provider to contact us for prior authorization for those services. Individual dental plan. You are leaving our Medicare website and going to our non-Medicare website. Available online provider directories (PDF): CALIFORNIA county of SAN DIEGO EAE Preferred Plan HMO D-SNP Some subtypes have five tiers of coverage. Aetna is part of the CVS Health family of companies. Your InstaMed log in may be different from your Caremark.com secure member site log in. Use the drop-down menu to find your state. Under our visitor/traveler program you may receive all plan covered services at in-network cost-sharing when you see a network provider. OFFICE OF ATTORNEY GENERAL COMMONWEALTH OF PENNSYLVANIA NEW EMPLOYEE BENEFITS SUMMARY BOOKLET REVISED OCTOBER 2020 HUMAN RESOURCES SECTION 14TH FLOOR, STRAWBERRY SQUARE, HARRISBURG 717.787.5175 Important Notice: This booklet is a summary of benefits available to Commonwealth of Pennsylvania employees. If so, you or your provider can ask us for a pre-service organization determination. 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 enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. The ${planType} network providers in this directory have agreed to provide you with your health care services. You can find a complete listing of health plans and their NCQA status at ncqa.org. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. The member's benefit plan determines coverage. Copyright document.write(new Date().getFullYear()) Aetna Better Health of Pennsylvania, All Rights Reserved. You are leaving our Aetna Medicare website and going to an Aetna Medicaid website. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). This is any specific area of medicine in which a provider may focus his/her practice. You can use these links to find in-network providers and pharmacies near you. If you receive covered services from an out-of-network doctor, its important to confirm that they: Please see your Evidence of Coverage for the most up-to-date service area listing. Provider Search is provided solely for the personal, non-commercial use of current and prospective Aetna members and providers. Unlisted, unspecified and nonspecific codes should be avoided. Sapphire365 This tool also helps to determine if a special program applies. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. The ABA Medical Necessity Guidedoes not constitute medical advice. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Visit the secure website, available through www.aetna.com, for more information. 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). PCP and referral rules still apply. Links to various non-Aetna sites are provided for your convenience only. Your member ID will contain 12 numeric characters. 2023 Spouse Attestation Click Here to Log In Click here for more information on phone scams Other pharmacies, physicians and providers are available in our network. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. How to find providers in your area The directory tool lets you search for: A provider, by entering a ZIP code, county or city A provider's name, facility, specialty or condition A hospital or urgent care center You may have to select a product or plan name to complete the search. Primary care physicians, specialists, mental health providers and family planning providers, Hospitals, federally qualified health centers (FQHCs), rural health clinics (RHCs) and long-term care, skilled nursing and mental health facilities, Adult day services, assisted living, home-delivered meals, home health agencies and home medical equipment providers. However, we encourage you to do so. 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. See the Report Cards tab to search on Health Plans.. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. By clicking on I accept, I acknowledge and accept that: Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". You have the flexibility to receive covered services from network providers or out-of-network providers. Others have four tiers, three tiers or two tiers. Managed Behavioral Healthcare Organizations for behavioral health accreditation. The information you will be accessing is provided by another organization or vendor. Call a licensed agent at 1-855-335-1407 (TTY: 711) , Monday to Friday, 8 AM to 8 PM. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Health benefits and health insurance plans contain exclusions and limitations. Includes PPO, HMO, HMO-POS medical plans with or without drugs. You are now being directed to CVS caremark site. Caremark.com is the secure website where Aetna Medicare SilverScript members can manage prescriptions, sign up for mail delivery, view order status, find drug pricing, and identify savings options. You will be notified when a coverage decision is made. PEBTF - Home The Appointment of Representative form is on CMS.gov. This information is neither an offer of coverage nor medical advice. You are now being directed to the CVS Health site. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Your member ID will contain 12 numeric characters. PDF Choice PPO Pennsylvania Employees Benefit Trust Fund Active Members - PEBTF This search will use the five-tier subtype. 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. The AMA is a third party beneficiary to this Agreement. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Page Redirection - Aetna Were bringing you to our trusted partner to help process your payments. Treating providers are solely responsible for medical advice and treatment of members. Check with your pharmacy to see if they offer the services you need to fill a prescription. This is any specific area of medicine in which a provider may focus his/her practice. Then click the link for your health plan. Well determine your cost-sharing amount, if any. Some subtypes have five tiers of coverage. Plan from an employer Individual health plan Individual dental plan Aetna Medicare plan Aetna Medicaid plan The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. There are exceptions for certain direct-access services. Explore our savings, quality care and wellness solutions to craft the perfect plan for your business. Check it out at www.aetna.com/pebtf . Most printed directories come with both English and Spanish text included. We are committed to accreditation by the National Committee for Quality Assurance (NCQA). In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. CPT is a registered trademark of the American Medical Association. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 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). Aetna Inc. and itsaffiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Search by CPT code In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. New and revised codes are added to the CPBs as they are updated. 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). You dont need a referral to visit network providers to receive covered services. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Find a provider Use the drop-down menu to find your state. 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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Updates may also be affected by interruptions due to system maintenance, upgrades or unplanned outages. Provider / Facility Name Specialty Select a Specialty * = Required No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. We may need more information if the nature of the urgent or emergency issue doesnt qualify for coverage. This site has its own log in. Caremark.com is the secure website where Aetna Medicare SilverScript members can manage prescriptions, sign up for mail delivery, view order status, find drug pricing, and identify savings options. You can find a network doctor in this directory. Your member ID will contain 12 numeric characters. Links to various non-Aetna sites are provided for your convenience only. Enter the Aetna Member ID that is on your card. Your member ID will contain 12 numeric characters. You may have to select a product or plan name to complete the search. **FOR EXTRA BENEFITS CARD: Check your Summary of Benefits to see if your Extra Benefits Card can be used for other things such as OTC items, transportation and utilities. For language services, please call the number on your member ID card and request an operator. Therefore, NCQA provider recognition is subject to change. And we can help get you there. Call your PCP if a delay in treatment would not be harmful to your health. Youll need to use our dedicated network of local providers. Our claims/billing address is on your member ID card. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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. Provider Directory - Aetna Better Health When billing, you must use the most appropriate code as of the effective date of the submission. If you do not intend to leave our site, close this message. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. We work closely with them to coordinate your care. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. For Aetnas commercial plans, there is no precertification required for buprenorphine products to treat opioid addiction. Select a state below to update coverage details. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Participating providers are required to pursue precertification for procedures and services on the lists below. Read more information on specialties (PDF). Contact the PEBTF; Directions; Health Plan Costs. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. It is only a partial, general description of plan or program benefits and does not constitute a contract. Links to various Aetna Better Health and non-Aetna Better Health sites are provided for your convenience. pharmacy, dental or vision providers? The link for Other Healthcare Organizations includes: By using the provider search directory, you acknowledge and agree that all of the data contained within belongs exclusively to ${company} Inc. and is protected by copyright and other law. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits.