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This search will use the five-tier subtype. 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. Do you want to continue? The Applied Behavior Analysis ABA Medical Necessity Guide helps determine appropriate medically necessary levels and types of care for patients in need of evaluation and treatment for behavioral health conditions.

Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits.

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. 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. The member's benefit plan determines coverage.

Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis.

This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. Copyright by the American Society of Addiction Medicine. Reprinted with permission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM.

Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". See Aetna's External Review Program. All Rights Reserved. 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.

State Street, Chicago, Illinois Applications are available at the American Medical Association Web site, www. Go to the American Medical Association Web site.

Department of Defense procurements and the limited rights restrictions of FAR CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT.

The responsibility for the content of this product is with Aetna, Inc. 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. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services.

This information is neither an offer of coverage nor medical advice. It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.

Working with us. Join our network. Confirm patient eligibility Precertification lists and CPT code search. Existing health care professionals. Availity provider portal Update your data Utilization management Provider referral directory. Electronic claims. Disputes and appeals. Cost estimator and fee schedules. Pharmacy claims. Dental claims. Pharmacy services.

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State regulations Federal regulations. News and Insights. OfficeLink updates newsletter. Company news. Existing health care professionals Availity provider portal Update your data Utilization management Provider referral directory. Pharmacy Pharmacy services Update pharmacy data Find prescription drug coverage. Resources Clinical policy bulletins Clinical policy bulletins Clinical policy bulletin overview Medical clinical policy bulletins Dental clinical policy bulletins Pharmacy clinical policy bulletins.

Education, trainings and manuals Overview Educational webinars Provider manuals Behavioral health trainings. Regulations State regulations Federal regulations. Electronic transaction vendors. Transactions available. Does site support browsers other than Internet Explorer IE? Change Healthcare formerly Emdeon. Experian Health formerly Passport Health.

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Health benefits and health insurance plans contain exclusions and limitations. You are now being directed to the AMA site Links to various non-Aetna sites are provided for your convenience only.

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Tools like web scraping, advanced data analytics, and provider registries are critical to evaluating if payers have appropriate network adequacy for their members. Additionally, price transparency is critical for members. In the past two years, 1 in 5 insured adults had an unexpected medical bill from an out-of-network provider and more than two-thirds of adults worry about affording unexpected medical bills.

Advanced analytics can help payers, providers, and members provide data on prices across providers to help all parties make more informed care choices. Therefore, I see an opportunity to close the last mile of paper payments transitioning to e-payments, to speed up reimbursements and to reduce the time and money spent cashing checks.

As an industry, we must move at pace to take advantage of the electronic payment systems that are at our fingertips and meet the demands of an increasingly digital population. If we can remove even more paper caught up in the healthcare payment experience by using smart technology and digital communication tools, it will benefit us all. To improve accuracy and efficiency with our spending, we must combine investment in artificial intelligence such as machine learning, natural language processing, and robotic process automation, as well as integrating claims, provider, and payments data to harness intelligence from siloed data assets.

It is vital to the sustainability of our healthcare system that we ensure payment integrity. But it requires widespread adoption of data-driven payment accuracy processes to do at-scale. When we apply these same principles of investment to an industry that touches every American and dramatically needs improvement, the outcome can be truly transformative and create positive and meaningful outcomes for society.

Get the latest articles, events, webinars, and more in our monthly digest. The Payment Harmonization Index is here. Learn More. Search Search. April 20,

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