Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutions

March 2012 • Volume 9, Issue 1

Southeast Region

Inside This IssuePolicy and Coding Updates 2-3

Electronic Solutions 4

Office News 5-6

Learning Opportunities 7

Southeast News 10

Options to reach us•Go to www.aetna.com•Select “Health Care

Professionals”

•Select “Medical Professionals Log In”

Or call our Provider Service Center:

• 1-800-624-0756 for HMO-based benefitsplans,MedicareAdvantage plans and WA Primary Choice plan

• 1-888-MDAetna (1-888-632-3862) for all other plans

TheOctober1,2013compliancedeadlinefornew coding standards is approaching. We encourageyoutodevelopaprojectplan,thinkabout budget planning and meet with all impacted areas of your organization.

Thiscanbecostlyandtime-consuming,soweurge you to plan now to meet this date. Accordingtoindustrysurveys,developingaprojectplanforconvertingtoICD-10isamajorconcernforprovidersandtheirstaff.  

Tolearnhowtodevelopaprojectplan,click here.

More resources

•LogintotheAetna Education Site . From the toptoolbar,select“OfficeStaffCourses”then“Coding”and“HIPAA5010TransactionUpgradeOverview”and“ICD-10Overview.”

•Click heretogotoAetna’s“5010,ICD-10andNPI” web page.

Who must comply

All health care providers who use standard electronic transactions and all health plans and clearinghouses must comply with the new transaction and coding standards.

We plan to meet all applicable timeframes forcomplianceandwillworkcloselywithyou, as well.

Do you have an ICD-10 conversion plan?

It’s easier than ever to update or correct your office’sorfacility’sphoneandfaxnumber(s),mailing addresses and e-mail addresses.

Use our new Request Changes to Provider Data form. It’s located on our DocFind® provider directory.

Updating this information will help ensure that you receive important information we distribute – whether by e-mail or on paper. It also will provide patients who use DocFind with the most up-to-date and accurate information about where you’re located or how to reach you.

How to update your demographic information

48.22.808.1-Q1-SE(3/12)www.aetna.com

Aetna OfficeLink UpdatesTM

2 Aetna OfficeLink Updates

Procedure Implementation date

What’s changed

95165 – Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens

6/1/2012 95165willbeallowed30timesperdateofservice.

D9610–Therapeuticparenteraldrug,singleadministration

6/1/2012 D9610willbedeniedasincidentalwhenbilledwithcodesD9220,D9221,D9241orD9242.Modifier59willoverridetheedit.

Medicare status codes (P and M) 6/1/2012 CodesdesignatedwithaP(bundled/excludedcodes)orM(measurement code for reporting services only) Medicare Physician Fee Schedule status code is not payable and will be denied.

J9055–Injection,cetuximab,10mg 6/1/2012 Effective6/1/2012, cetuximab(Erbitux)willbeconsideredexperimental and investigational for the treatment of glioma and vaginal cancer. Refer to Clinical Policy Bulletin #0684 (Cetuximab(Erbitux))formoreinformation.

QualitativedrugscreencodesG0431&G0434

6/1/2012 Starting6/1/2012,wewillrequiretheuseofeitherG0431orG0434forthebillingofqualitativedrugscreens.

Wewillreimbursefor1unit,perpatientencounter,ofeithercodewhenqualitativetestingmethodsareused.AnybillingofCPTcodes80100,80101or80104willbeadjudicatedaccordingtothispolicywithappropriatemappingtooneunitof G0431orG0434perpatientencounter.

Inappropriate billing or coding Annual reminder Wemakecodeadjustmentsforinappropriatebillingorcoding.Examplesoftheseadjustmentsincluderebundlingofservicesthatareconsideredpartof,incidentalto,orinclusivetotheprimary procedure as well as adjustments for mutually exclusive procedures.

93224–93227–Externalelectrocardiographic recording up to 48 hours by continuous rhythm recording and storage

Reminder 93224–93227areusedtoreportexternalelectrocardiographicrecording services of up to 48 hours. These procedure codes should be reported once within a 48 hour time period.

Policy and Coding Updates

Clinical payment, coding and policy changesWeregularlyadjustourclinical,paymentandcodingpolicypositionsaspartofourongoingpolicyreviewprocesses.Indevelopingourpolicies,wemayconsultwithexternalprofessionalorganizations,medicalsocietiesandtheindependentPhysicianAdvisoryBoard,which provides advice to us on issues of importance to physicians. The accompanying chart outlines coding and policy changes:

Shingles vaccine is covered for ages 60+ AlthoughtheFDAhasapprovedusefor50yearsandolder,wearefollowing the recommendations of the Centers for Disease Control’s (CDC) Advisory Committee on Immunization

Practices(ACIP),whichrecommendsashinglesvaccineforpersonsage60yearsandolder.Tolearnmore,readtheClinical Policy Bulletin online – search for #115.

InourDecemberissue,wenotedthateffectiveMarch1,2012,allmarketswillrequirepreauthorizationforpolysomnography.ThischangewilltakeeffectinTexasbeginningMay1,2012.Wealsowishtoclarifythatpreauthorizationisrequiredonlyinmarkets

where the radiology benefits management program currently applies.AdditionalinformationfromAetnaandMedSolutions,Inc.or CareCore National will be forthcoming

Clarification: Polysomnography precert requirements

3 MARCH 2012

EffectiveJune1,2012,wewillrequirepreauthorization for non-emergent cardiac implant devices.

This affects all plans. This change includes Aetnapatientswhoalreadyrequirepreauthorization through our current high-tech radiology imaging preauthorization program.

AsofJune1,2012,providersinallstates,exceptNewYorkandNewJersey,shouldcontactMedSolutionstorequest

preauthorization. You can reach MedSolutions:

•Onlineat www.medsolutionsonline.com

•Byphoneat1-888-693-3211

•Byfaxat1-888-693-3210

ProvidersinNewYorkandNewJerseyshould contact CareCore National to requestpreauthorization.YoucanreachCareCore National:

•Onlineatwww.carecorenational.com

•Byphoneat1-888-622-7329 in New Yorkor1-888-647-5940 in New Jersey

•Byfaxat1-888-444-1562

The following precertification changes are effectiveonJuly1,2012:

•AetnaisaddingProtonBeamRadiotherapy to the NPL

•Thephoneandfaxnumbersforalldrugson Aetna’s NPL will be centralized:

- Phone: 1-866-503-0857

- Fax: 1-888-267-3277

A reminder about a previously communicated addition to Aetna’s National Precertification List:

•Adceteris*–requiresprecertificationeffectiveMay1,2012

ToreviewtheNPL,click here.

Preauthorization now required for cardiac implant devices

Changes to the National Precertification List (NPL)

4 Aetna OfficeLink Updates

We offer a variety of electronic options on our secure provider website.

Our electronic transaction vendors also offer electronic options. We encourage you to use these transactions to suit your needs andmakeyourinteractionswithuseasier.

Ifyoudon’thaveausernameandpasswordtoourwebsite,click here.

The new year means new plans for your patients.Copayments,coinsurance,anddeductibles might not be the same as last year. These tools can help:

Our Eligibility and Benefits Inquiry (E&B):

•Givesyoureal-timeinformation

•Letsyouverifypastbenefits,copayments,coinsurance,anddeductibleamounts

Our Provider Payment Estimator:

•Showsyoupatientresponsibilityamountsbefore or at the time of service

•Supplementseligibilitywithestimatesthatshowcopayments,coinsurance,anddeductiblesusingclaimsdata,youroffice’sfeeschedule,andclaimsprocessing rules

•Enablesyoutoprinttheresultstosharewith patients prior to rendering services

•Nowoffersenhancedresponsesforpatients who have tiered benefit plans

•IsavailableonAetna’ssecureproviderwebsite

Forservicesrequiringpriornotification,why wait on the phone when you can submityourrequestsonlinefromoursecureproviderwebsite?Or,byusinganother vendor that offers this transaction?

•RecentenhancementstothePrecertification Submission transaction on our secure provider website include:

- Dynamic pages – depending on the type ofprecertificationrequest(Inpatient,

Outpatient,DME,Ambulance,orOffice),yourchoicesdirectyouwhattofill out next

- TransactionsmovefromE&BtoPrecertification without having to re-enter patient information

- Contact information saves the last name entered

- Precertification Status Updates are accessible via daily alert when a submittedprecertificationrequesthasastatus change

Training

We offer a “Hands on the Keyboard” electronic precertification training Tuesdaysat1p.m.ET(inpatient)orWednesdaysat2p.m.ET(outpatient/DME).Toattend,e-mailyourname,practicenameandaddress,andtelephonenumber to PeSHOTKePrecertTraining@aetna.com. An Aetna representative will contact you.

Whether you recently began using electronicEOBsorarelookingforaneasierwaytoreconcileyourAetnaEOBs,you can get electronic copies of your EOBs from our secure provider website. Registered userscanaccesselectronicEOBcopiesforup to the past two years.

ElectronicEOBsgohandinhandwithElectronic Funds Transfer (EFT)

•EnrollinEFT,andreceiveclaimspaymentsuptoaweekfasterthanbypapercheck.Paymentsaredirectlydepositedintoyourbankaccount(s)

•EFTisfreeandyouraccountinformationis secure

•GetanEFTenrollmentformhere

We also offer Electronic Remittance Advice (ERA) to offices able to receive these files. Click here to learn more aboutERAandtogetanERA/EFTenrollment form.

Submit all of your claims electronically,includingyoursecondaryclaims. (Click here to learn how to submit secondary claims to us.)

•Registeredusersofoursecureproviderwebsitecansubmitallofyour claims electronically – free of charge

•Youcanalsouseoneofourelectronic transaction vendors

We’resocommittedtoprocessingyourclaimsasquicklyaspossible that we’ve signed onto the American Medical Association’s pledge to “Heal the Claims Processtm Campaign.”

Aetna’s EDI transactions – making it simple for you in 2012

Verify benefits, see patient responsibility amounts

Reminder: submit your precerts online

Advantages of electronic EOBs, EFT, ERA

Want your claims paid faster? Here’s how

Electronic Solutions

4 Aetna OfficeLink Updates

5 MARCH 2012

Statisticsshowthat20to80percentofpatientsdon’ttaketheirmedicationasprescribed.Asmanyas83percentdon’ttell their physician that they aren’t planning to fill their prescription(s).1Patientstakemedications based on their understanding of their diagnosis and treatment plan.

Effective communication

The good news is prescribers can improve medication adherence by communicating more effectively with their patients. These strategies can help: 2

• Give clear information about the patient’s condition. Using simple language is crucial to patients’ understanding of their illness. It will help

themmakedecisionsabouttheirmedications.

• Involve the patient in the plan. Patients want to discuss how the medication works,itsbenefits,efficacy,sideeffectsand any alternate therapies. This knowledgehelpspatientsfollowtheirprovider’s recommendations.

• Foster a relationship of trust. There’s a linkbetweenthepatient/practitionerrelationship and medication adherence. Studies show that when this relationship isstrong,adherenceisbetter.

Online resources

Checkouttheseprovider/patientresourceson our secure provider website under Clinical Resources:

• Medication Adherence Assessment Form –Takingyourmedicinesasprescribed is important

•Fact Sheet – Helping your patients overcome barriers to medication adherence

• Tip Sheet – Tips to help remind you to takeyourmedicine

1BensonJ,BrittenN.(2002).Patients’decisionsaboutwhetherornottotakeantihypertensivedrugs:qualitativestudy.BMJ.325,873-877.

2 ZolnierekK,DiMatteoR.(2009).Physiciancommunication and patient adherence to treatment: a meta-analysis. Med Care.47(8),826–834.

Beginningthisspring,beonthelookoutforpatients with Aetna ID cards sporting our newlogo.(Duringthistransition,youcanstill accept ID cards with the old logo.)

Youmayhavenoticedournewlook.We’reproud of our vibrant colors and bold logo. They capture our passion for building relationships with our members and providers.

Click heretorequestpermissiontodownload a copy of our new logo for your website or office.

Watch a video to learn more about our commitment to connecting our members to healthier living.

We’re continually changing to help our members feel confident in their health care

decisions,andmakeiteasierforthemtolive healthier. Our new logo reflects this promise.

Where to find product type on ID cardsThenumberonyourpatient’smemberID(e.g.,Worotheralphanumeric)shouldnotbeusedasanindicator oftheproducttype.Instead,you’ll find the product type in the upper right corner of the patient’s member ID card.

Youcancontinuetogeteligibilityandbenefitsinformationonline,usingoursecure provider website.

Help us promote medication adherence

TheCentersforMedicare&MedicaidServices(CMS)hasestablishedspecificmarketingguidelinesforcommunicatingwithMedicarebeneficiaries.ToreviewCMSmarketingrequirements,seetheirFinal 2012 Medicare Marketing Guidelines (scroll to bottom of page to access the files).

Any Medicare-related communications you develop that reference Aetna and that you intend to distribute to Aetna Medicare members mustbereviewedandapprovedbyAetnaandCMS,whererequired,priortodistribution.YourAetnanetworkrepresentativecanhelpyougettherequiredAetnaandCMSapprovals.

Contact us for approval of communications that mention Aetna

Aetna’s face is changing – here’s why

Medicare

Office News

6 Aetna OfficeLink Updates

InourHealthCareProfessionalToolkit,available on our secure provider website,you’ll find information about our case management and disease management programs.

TheToolkithasinformationthatcanhelpyou serve your Aetna patients efficiently andaccurately.TheToolkitisastreamlined,comprehensive office manual that contains information about:

• Clinical Practice and Preventive Service guidelines

•Aetna policies and procedures

•Patient management and acute care

•Specialmemberprograms/resources,including the Aetna Women’s HealthSM Program,AetnaCompassionateCareSM and others

Click heretoaccesstheToolkit.Or,afterloggingintooursecurewebsite,select“DoingBusinesswithAetna”fromtheAetna Support Center.

Ifyoudon’thaveInternetaccess,callourProvider Service Center for a hard copy:

• 1-800-624-0756 for HMO-based benefitsplans,MedicareAdvantageplansand WA Primary Choice plan.

• 1-888-MDAetna (1-888-632-3862) for all other plans.

Our online Toolkit has useful information

Younowonlyhavetouseonephone/faxnumber when contacting us for drug precertification for all drugs on the Aetna Participating Provider Precertification List. Beginusingthesenumbersimmediatelywhen contacting us for drug precertification:

•Phone: 1-866-503-0857

•Fax: 1-888-267-3277

 Asareminder,drugsonthelistaresubjecttoprecertificationforallbenefitsplans,excluding Traditional Choice plans. View the Precertification List for a full list of drugs.

Medication forms

YoucanfindMedicationRequestformsonour secure provider website. Once logged in,select“AetnaSupportCenter”fromtheAetnaPlanCentralhomepage,then“Forms Library” and “Pharmacy Forms.”

We update the Aetna Medicare and Commercial (non-Medicare) Preferred DrugLists,alsoknownasourformularies,

at least annually and from time to time throughout the year.

•GotoourMedicare formulary

•GotoourCommercial Preferred Drug List

Forpapercopiesoftheseguides,call1-800-AetnaRx (1-800-238-6279).

Note our one phone number for drugs needing precert

Links to our Medicare and Commercial formularies

Aetna can now accept your Medicare Part A claims electronically.

ReviewyourMedicareExplanationofPayments for one of these two codes: MA18 or N89. If you see one of these codes,thenMedicarehasautomatically

sent your Part A claim to Aetna. There is no need for you to send in a claim. You can checkclaimstatuswithourelectronicClaimStatusInquirytransactionandfollowupwithusin30days,ifneeded.

Formoreinformation,visitourdedicatedCOB claims page.Fromthere,usethe“ContactAetna”linktosubmitquestions.

We now accept Part A claims

7 MARCH 2012

Learning Opportunities

Aetna’sEducationSiteforHealthCareProfessionals

Log in or register at www.AetnaEducation.com.

New and updated courses for physicians, nurses and office staff

Cultural Competency

•New Cross-Cultural Issues in Genetic Counseling

Reference Tools

•New Products,ProgramsandPlans:PassportToHealthcare®

•UpdatedProducts,ProgramsandPlans:Aexcel® reference tool

•UpdatedProducts,ProgramsandPlans:NonparticipatingProvider Information: Aetna Medicare Plan (PPO)

•UpdatedProviderManuals:BehavioralHealthProviderManual

•UpdatedProviderManuals:EmployeeAssistanceProgram(EAP)Manual

Webinars

•New DoingBusinesswithAetnaLiveWebinar

Springrepresentsrenewalandchange.BeginninginMarch,ifyou“spring”intoeducation,you’llhaveanotherchancetolearnwithusandmaybewalkawaywithaprize.

To start:

•Logintowww.AetnaEducation.com.

•CompleteQualityInteractions®forHealthCareEmployeesorQualityInteractionsforPhysicians(2.5CMEcredits),oranyQuality Interactions refresher course. These courses are a great way to support National Minority Health Month in April.

Or,ifyouhavecompletedthecourseslistedabove,youcancompletethe“ICD-10Overview.”

Checkoutwww.AetnaEducation.comstartingMarch1,2012tolearn more.

March is National Nutrition Month

Pediatricians,nursesandofficestaff–wehavetrainingvideosreadilyavailabledesignedtohelp prevent children from being overweight.

In the GetNHealthy Nutrition Counseling Videos,IngerHustrulid,RD,LDN,ACSM,walksyouthroughbasiccommunication,counselingandinterviewtechniques.Thiscanhelpindividualsandfamiliesestablishlife-longhealththroughinnovativeprograms,interactiveactivitiesandnutrition counseling.

Taketimetoviewtheseresourcestoday;thisinformationwillgoalongwaytoencouragehealthy eating habits.

Toviewthevideos,logintowww.AetnaEducation.com. Select “Office Staff Courses” from thetoptoolbar,viewtheProducts,ProgramsandPlanscoursecatalog,thenselect“GetNHealthy Nutritional Counseling Videos.”

Download our course catalog

Explore our wide range of courses

“Spring” into a new season - you could win a prize

8 Aetna OfficeLink Updates

OurHealthCareProfessionalToolkit,available on our secure provider website,includes important information on all memberrightsandresponsibilities,including those about discrimination. It also contains information about accessibility standards.

Ifyoudon’thaveInternetaccess,callourProvider Service Center for a paper copy of theToolkit.

Non-discrimination policy

All participating physicians should have a documented non-discrimination policy. Federal and state laws prohibit discrimination in the treatment of patients onthebasisof:race,ethnicity,nationalorigin,religion,sex,age,mentalorphysicaldisability,medicalcondition,sexualorientation,claimsexperience,medicalhistory,evidenceofinsurability(includingconditions arising out of acts of domestic violence),geneticinformationorsourceofpayment.

All participating physicians or health care professionals may also be obligated under the Americans with Disabilities Act to provide physical access to their offices and reasonable accommodations for patients and employees with disabilities.

Accessibility standards

TheToolkitincludesaccessibilitystandardsfor primary care physicians. Accessibility standards for specialists are specific to yourstateandspecialty. Refertoyourprovider contract for details.

The National Committee for Quality Assurance(NCQA)requireshealthplanstoregularly inform providers about the availability of Clinical Practice Guidelines (CPGs).

We base our CPGs and Preventive Service Guidelines (PSGs) on nationally recognized recommendations and peer-reviewed medical literature. They are located on our secure provider website under “Aetna Support Center” then “Clinical Resources.”

•Preventive Service Guidelines –Adopted2/12

•Behavioral Health

- HelpingPatientsWhoDrinkToo Much–Adopted2/12

- Treating Patients With Major Depressive Disorder–Adopted2/12

•Diabetes

- Treating Patients With Diabetes –Adopted2/12

•Heart Disease

- Treating Patients With Coronary Artery Disease–Adopted10/10

ForahardcopyofPSGs,oraspecificCPG,call our Provider Service Center.

We want you to be aware of important program information that can help you and your patients.

Weintegratequalitymanagementandmetricsintoallwedo.Fordetailsonourqualitymanagementprogram,itsgoalsandour

progresstowardthosegoals,logintooursecure provider websiteandselect“AetnaSupportCenter”,“DoingBusinesswithAetna”,then“QualityManagementProgram”.PracticeswithoutInternetaccesscanrequestapapercopybycallingourProviderService Center.

Review our policies on non-discrimination, accessibility

Consult Clinical Practice Guidelines in caring for patients

Keeping you and your patients informed

8 Aetna OfficeLink Updates

9 MARCH 2012

It’s easy to locate information about our utilizationmanagement(UM)criteria,ClinicalPolicyBulletins(CPBs),PharmacyClinicalPolicyBulletins(PCPBs),andtheavailability of our medical directors.

UM criteria

Patient Management staff applies evidence-based,clinicalcriteriafromnationally recognized authorities as guidance when rendering UM decisions. They apply these criteria to the clinical information collected. This process applies toprecertification,inpatientreviewandretrospective review decisions.

Toviewthecriteriaused,click here for PolicyBulletinsandhere for Determining Coverage. Or:

•Gotowww.aetna.com and select “Health Care Professionals”

•Choose“Policies&Guidelines”then“PolicyBulletins”or“DeterminingCoverage”

For a copy of the criteria upon which a specificdeterminationwasbased,callourProvider Service Center.

CPBs and PCPBs

CPBsandPCPBsexplainandguideAetna’sdeterminationofwhethercertainservices,medications or supplies are medically necessary,experimentalandinvestigationalorcosmetic.CPBsandPCPBscanhelpyouassesswhetheryourpatient meets our clinical criteria for coverage. They can also help you plan a course of treatment before calling for precertification,ifrequired.

ToviewCPBs,click here. If you don’t have Internetaccess,callourProviderService

Centerforahardcopy.ForaPCPB,callPharmacy Management at 1-800-670-3566.

Provider Service Centers

•1-800-624-0756 for HMO-based benefitsplans,MedicareAdvantageplansand WA Primary Choice plan

•1-888-MDAetna (1-888-632-3862) for all other plans

Medical director availability

Aetna medical directors are available 24hoursadayforspecificUMissues.Physicians can contact Patient Management and Precertification staff at the telephone number on the member’s ID card. When only a Member Services numberisshownonthecard,youwillbedirected through either a phone prompt or a Member Services representative.

Aetna staff or our contracted representatives are contacting your office to collect medical record information from ourmembers’visitsin2011.Ourlargestcontracted representatives include MedAssurantTM and MediConnect.

Why this is necessary

HealthcareEffectivenessDataandInformationSet(HEDIS)datacollectionisanationwide,collaborativeeffortamongemployers,healthplansandphysicians.The goal is to monitor and compare health plan performance as specified by the National Committee for Quality Assurance (NCQA).

AsaMedicareAdvantageorganization,wearerequiredtosubmitmemberdiagnosisdata to Centers for Medicare & Medicaid Services (CMS) on an ongoing basis. Most data is collected from claims and encounters. We also gather some diagnosis codes from member medical records.

We need your help

Ifcontacted,weaskyoutocooperatebygranting access to our members’ medical records within the provided timeframe. Our contractedrepresentativeswillworkwithyou and can provide options for sending in medical records.

HIPAA guidelines

Our representatives serve Aetna in a role that is defined and covered by the Health Insurance Portability and Accountability Act(HIPAA).UnderHIPAA,AetnaisaCoveredEntityandourrepresentatives’roleisasaBusinessAssociateofaCoveredEntity.Providingmedicalrecordinformation to us or our contracted representatives complies with HIPAA regulations.

* HEDIS is a registered trademark of the National Committee for Quality Assurance.

Where to find UM, clinical policy support information

HEDIS®* 2012 data collection underway

10 Aetna OfficeLink Updates

Southeast News

Everytwoyears,weconductanaudittoassess how health care professionals are complying with our medical record documentation criteria.

Weevaluated23documentationcriteriacategories in the Southeast Region. Of those,thesethreeareasfellbelowthe85percentcompliancegoal,andarebeingtargeted for improvement:

•Advancedirectivesgivenbyapatientmust be in a prominent part of the record

•Documentationofadvancedirectivesforpatients >18 years of age

•Ageappropriateimmunizationrecordpresent

Our documentation criteria are in our HealthCareProfessionalToolkit,locatedon our secure provider website. Tools to help improve medical record documentation are also on our website and include the following forms:

•AdultHealthMaintenanceForm

•MedicalHistoryForm

•PediatricHealthandImmunizationSummary Forms

Advance directives

Inyourpatients’charts,youmustdocument whether a member has prepared an advance directive. Aetna Participating Practitioner Medical Record Criteriarequirethatadvancedirectives(executed or not) are in a prominent place

in the patient’s record (except for patients underage18).ForMedicarepatients,suchdocumentationisrequiredbytheCentersforMedicare&MedicaidServices,forwhich we must monitor participating physician compliance.

Find advance directive forms for specific states at www.aetnacompassionatecare.com. If the state you practice in is not listed,gotohttp://uslwr.com/formslist.shtm for an applicable advance directive form or for additional information.

Ifyoudon’thaveInternetaccess,youcanrequestapapercopyoftheToolkitbycalling our Provider Service Center.

Results of our 2011 Medical Record Audit

11 MARCH 2012

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www.aetna.com

©2012AetnaInc.48.22.808.1-Q1-SE(3/12)

The information and/or programs described in this newsletter may not necessarily apply to all services in this region. Contact your Aetna network representative to find out what is available in your local network. Application of copayments and/or coinsurance may vary by plan design. This newsletter is provided solely for your information and is not intended as legal advice. If you have any questions concerning the application or interpretation of any law mentioned in this newsletter, please contact your attorney.

BeginningApril1,2012,manyAetnamembers in commercial (non-Medicare) plans will have access to two new clinical pharmacy programs. We designed these programs to help improve patient safety.

Maximum Dose: Throughthisprogram,wewill inform physicians about the maximum daily dose suggested in product labeling. WewillidentifyAetnamember(s)who,accordingtoourrecords,maybeonadosethatexceedsthisrecommendation,andnotify their providers.

Length of Therapy: This program identifiespatientswhohavetakenadrugfor longer treatment duration than approved by the Food and Drug Administration(FDA),orsupportedbyclinical evidence. We will remind physicians about the defined length of therapy suggested in the product labeling. We also willidentifyAetnamember(s)who,accordingtoourrecords,mayhaveexceededthesuggestedlengthoftherapy,and notify their providers.

Withbothprograms,wewillaskphysiciansiftheybelieveitisnecessarytokeepprescribing the medication in the same way,inlightofthepatient’smedicalcondition,andtoconsideranyrisksorbenefits that continuing therapy may represent.

PRSRT STDU.S. POSTAGE

PAIDPERMIT NO. 12

ENFIELD, CTCPE RW3H151 Farmington Ave. Hartford, CT 06156

Contact us at: OfficeLinkUpdates@aetna.com

Route this publication to:

OfficeManager

ReferralandPrecertificationStafft

BusinessStaff

FrontDeskStaff

MedicalRecords/MedicalAssistants

Primary Care Physicians

Specialists

PhysicianAssistants/Clinical

Nurse Specialists

Nurses

“Aetna” is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. The Aetna companies that offer, underwrite or administer benefit coverage include Aetna Better Health Inc., Aetna Health Inc., Aetna Health of California Inc, Aetna Dental Inc., Aetna Dental of California Inc., Missouri Care, Incorporated, Aetna Life Insurance Company, Aetna Health Insurance Company of New York, and Aetna Health Insurance Company. Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC.

New pharmacy programs can help with patient safety