¹Ü¼ÒÆÅÐÄË®ÂÛ̳

Mental Health

• - Information and support for mental health. 
• - Resources to address tragedy and times of uncertainty.
• - Depression resources for patients and clinicians. 

Telehealth

• - Learn about Aetna’s virtual care services and member benefits. 
• - The Aetna health plans give access to virtual care through Teladoc.

Prior Authorization

• - Requestions authorizations for selected procedures and submit requested clinical information. 
• - Precertification information and lists for procedures and services. 
• - Changes to Aetna’s NPL effective 9/1/2022 to commercial and Medicare plans. 
  • Submit precertification requests though the . 

Value-Based Programs/Alternative Payment Models

• - Michigan
• - Delaware

Medicare Advantage

• - Information about Medicare compliance requirements, training, enrollment, appeals and more.

Recent News

• - Past and present Aetna newsletters and important reminders. 

Behavioral and Mental Health

• - Search by state for behavioral health related information. 
•  - Prior authorization form for behavioral health treatment.

Telehealth

• - Learn about Anthem’s virtual care services and how to use the Anthem Sydney app.

Prior Authorization

•  - Search for your state for prior authorization specific information such as code lists, precertification lists, polices, and guidelines. 
• - Prior authorization request form or inpatient or outpatient visits. 
• - General precertification request form. 

Value-Based Programs/Alternative Payment Models

• - Search for your state to review Anthem’s reimbursement policies and the basis for reimbursement if the service is covered by Anthem.
• - Anthem has a strategic relationship with Availity to serve their Electronic Data Interchange (EDI). Register here to exchange claims electronic transactions with Anthem.
• - Search by state to learn more about Anthem’s value-based care program.

Medicare Advantage

• - Information on understanding the MA program, virtual care, and using MA encounter data. 
•  - Information for providers with access to information about our plans and member benefits, news and updates, training materials and guides.

Recent News/Other

• - Search by state and stay current on Anthem policies and processes, updated clinical guidelines and other issues impacting practices and patients. 
• - Search by state and use these tools needed to deliver quality care and support patients and staff. 

• - Information on MA costs, limits and considerations, and enrollment. 
• – Articles and resources hub on the importance of value-based care for patients and clinicians.

Behavioral and Mental Health

• - Information and tools to help patients stay emotionally resilient and foster well-being. Includes behavioral health resources for patients, reimbursement for preventive care services and screenings, screening tools, and more. 
• - Includes clinical practice tools, behavioral administrative guidelines, and more treatment guidelines. 

Telehealth

• - Learn about Cigna’s virtual care options including preventive, urgent, and behavioral/mental health care. 
• - Read Cigna’s virtual care reimbursement policy to continue receiving ongoing reimbursement for virtual care. 

Prior Authorization

• - Guidelines on when and where to submit precertification requests to Cigna and Cigna’s national ancillary vendors. This includes service specific precertification process guidelines- medical procedure, medications, and behavioral. 
• - Find the most recent Medical Necessity Review list, precertification policies, and modifiers and reimbursement policies. 
• - Complete list of services that require precertification of coverage. 

Value-Based Programs/Alternative Payment Models

• - Collaboration between Cigna and a physician practice that's responsible and accountable for the population it serves.

Medicare Advantage

• - Providers manuals and resources for treating MA patients.

Recent News

• - Past and present Cigna policy updates. 

Behavioral and Mental Health

• - Evidence-based treatment options for common behavioral health conditions.
• - Tools and resources to screen for depression.

Telehealth

• - Technology requirements, eligibility and patient consent, patient marketing resources, comprehensive telehealth playbook, and FAQs.
• - Visit this page for all telehealth billing questions and answers. 

Prior Authorization

• - Includes prior, current, and future lists of services and medications for which preauthorization may be required and summaries of changes. Also includes information on submitting requests and state-specific forms.

Value-Based Programs/Alternative Payment Models

• - Details prevention, outcomes and utilization, and costs and payments for Humana individual Medicare Advantage (MA) members in 2023.
• - For episodes of care related to total joint replacement (hip and/or knee), maternity, spinal fusion (lumbar and/or cervical) and coronary artery bypass grafting.

Medicare Advantage

• - Information about the types of MA plans Humana offers. Here you will find reimbursement guidelines, details about provider qualifications and requirements, FAQs, and other information.

Behavioral and Mental Health

• - Use the access code ‘united’, then click on Mind & Body > Mental Health and/or Substance Use Disorder/Addiction.
• - Reference guide of resources to help screen patients for depression, Attention Deficit Hyperactivity Disorder (ADHD) and alcohol/substance misuse.

Telehealth

• - Information for members on benefits and coverage for telehealth services.
• - This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form or its electronic equivalent or its successor form. 

Prior Authorization

• - Submit, complete, and track prior authorizations and determine the need for notification. [requires login]
• - ACP met with UHC as part of their comprehensive effort to simplify the health care experience for consumers and providers. (3/29/2023)
• – This program applies to commercial, individual exchange, and Medicare Advantage plans and will allow certain physician practices to not submit prior authorization requests for a .
• State Gold Card Programs – UHC also has six state gold card programs in , , , , , and , which might have different requirements than the National Gold Card program.

Value-Based Programs/Alternative Payment Models

• - Information on Cancer Therapy Pathways and Cancer Episode programs.

Medicare Advantage

• - This guide provides information on topics such as claims and prior authorization. 
• - Coverage summaries, policy guidelines, and reimbursement policies for MA plans. Also included are clinical guidelines and terms and conditions for certain incentive programs.