Enter a zip code to search for dental care professionals in your area. Address, phone number, and practice changes. Looking for a local dentist? Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Aetna dental plans are not considered to be qualified health plans under the Affordable Care Act. Besides treating dental conditions, she educates her young patients on the importance of proper dental health and dispenses practical advice on maintaining dental hygiene. Due to the impact of the COVID-19 pandemic, many provider offices may need to adjust their office hours or redirect patients to others offices. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Just call Member Services at 1-866-329-4701 (TTY: 711) to learn more about these services. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. What's covered? Treating providers are solely responsible for medical advice and treatment of members. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. The DSNP network is in limited counties. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Others have four tiers, three tiers or two tiers. 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. Choose from the largest directory of in-person & video visit providers in the nation. All Rights Reserved. Please log in to your secure account to get what you need. If you have questions, visit our contact us page. HMO Plan*; Open Access Plan; QCHP/CDHP Plan; For step-by-step instructions, click on a plan below. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. All services deemed "never effective" are excluded from coverage. For language services, please call the number on your member ID card and request an operator. The path to healthy starts here. Need a new dental office home? ", Provider/facility name OR specialty is required to continue. This search will use the five-tier subtype. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Please refer to your Evidence of Coverage prior to contacting a Specialist if you are unsure, or call Member Services. Please contact Access2Care for benefit information by calling 1-866-252-5634 or visit www.Access2Care.net. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Health benefits and health insurance plans contain exclusions and limitations. Provider/Facility Name OR Specialty is required to continue, Please enter first and last name of Provider, or the name of the facility. The member's benefit plan determines coverage. Click here to find an in-network dental provider thats close to you. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. This Agreement will terminate upon notice if you violate its terms. Category: Health Detail Health. Treating providers are solely responsible for medical advice and treatment of members. Enter Location Details Zip Code: OR. 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 also can look for more than 25 other types of health care providers, including pharmacies, marriage counselors, urgent care centers, acupuncturists, drug and alcohol counselors, hospice care providers, dialysis centers, vision care providers, flu shot providers and physical therapists. Guardian is a registered trademark of The Guardian Life Insurance Company of America, New York, NY. Treating providers are solely responsible for dental advice and treatment of members. Aetna Dental Savings Plans are NOT dental insurance and the dental savings will vary by provider, plan and zip code. Aetna has one of the nation's largest dental networks, with more than 200,000 participating dental practices, making it easy to find a great dentist or specialist near you. Providers may not balance bill members who do not have cost-share responsibility (including QMB-only). Aetna Better Health of Maryland Dental Provider Search. It is only a partial, general description of plan or program benefits and does not constitute a contract. Request an Office Transfer. 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. If you have any questions about authorization requirements or need help with the search tool, contact Aetna Better Health Provider Relations at 1-855-364-0974. The member's benefit plan determines coverage. Check your participation status using the provider search tool. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Enter a zip code to search for dental care professionals in your area. . Neither Aetna Inc. nor its subsidiaries are Guardian affiliates. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Filter Type: All Symptom Treatment Nutrition Dental Services Aetna Medicaid New Jersey . The term prior authorization (PA) means the utilization review process determines whether the requested service, procedure, prescription drug or medical device meets the companys clinical criteria for coverage. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Aetna Better Health of Louisianais 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. Select a Plan * Select a Plan: 2. Copyright 2015 by the American Society of Addiction Medicine. Please log in to your secure account to get what you need. Your benefits plan determines coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. If you do not intend to leave our site, close this message. The DSNP network is in limited counties. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. 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. Treating providers are solely responsible for medical advice and treatment of members. VisitVision Provider Searchto view your vision providers. Benefit coverage may vary by plan or may be subject to special conditions. To reduce the The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. You are now being directed to CVS caremark site. Important information for Provider Search users who live in California , Colorado , Connecticut , Delaware , Florida . 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. 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. 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. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Enter your location by address, city or zip code. PA requirements are both Yes and No, as specified on the PA List. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. We're sorry but Provider Locator doesn't work properly without JavaScript enabled. Visit the secure website, available through www.aetna.com, for more information. 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). Members should discuss any Dental Clinical Policy Bulletin (DCPB) 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. Thanks! . Our find a dentist tool includes a brief survey to help us improve this service. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Choose the type of plan you're interested in to search for health care providers that accept it. The ABA Medical Necessity Guidedoes not constitute medical advice. For children and other Medicaid members, dental providers are available through MCNA. CMS requires providers to take the Model of Care training course (PDF). You can get dental care when you join Aetna Better Health of West Virginia. Applicable FARS/DFARS apply. All services deemed "never effective" are excluded from coverage. You can narrow your Aetna provider search by filtering provider characteristics, geographic location and best matched . CPT only copyright 2015 American Medical Association. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Aetna better health florida healthy kids. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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. A DSNP is a special type of Aetna Medicare Advantage Prescription Drug (MAPD) plan. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Learn about Aetna Smart Compare. Members must reside in a county where Aetna Medicare offers a DSNP. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. Directory of Dentists Treating Members with Intellectual Disabilities Adult. Helping you find the right doctor for you. Enter Location Do you want to continue? AetnaDentalOffers.com is brought to you by DentalPlans.com. Members should discuss any matters related to their coverage or condition with their treating provider. Experience and expertise to help our customers and members navigate the complex global health care landscape. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Treating providers are solely responsible for medical advice and treatment of members. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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. 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. 2023 DentalPlans.com, Inc. All Rights Reserved. Aetna Better Health. 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. By providing us with your email address, you agree to receive email communications from Aetna until you opt out of further emails. Find your plan listed below and click Find a Dentist. Disclaimer of Warranties and Liabilities. They also provide cosmetic services such as overlays and whitening treatments. Click here to request an office transfer. Please enable it to continue. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. CPT is a registered trademark of the American Medical Association. 2/22). 1999- Youd likely go to an oral surgeon if you have an impacted wisdom tooth or need another type of other complicated extraction. Links to various non-Aetna sites are provided for your convenience only. Links to various non-Aetna sites are provided for your convenience only. 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 start saving within 72 hours of joining a plan (no long waits before you , https://www.aetnadentaloffers.com/find-a-dentist, Health (1 days ago) WebAetna Smart Compare is a designation we give to doctors in our network who have proven time and again that they provide high-quality, effective care. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. 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). Did you find information that you think may need to be updated in our provider directories? 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. In case of a conflict between your plan documents and this information, the plan documents will govern. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. To get started: 1. There is no obligation to enroll. 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. You can further filter the search results by adding a specific dentist . While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Please log in to your secure account to get what you need. For enhanced adults benefit, visitDental Provider Searchto view your dental providers. Please note that providers listed in this directory may perform services that are not covered by your health plan. Unlisted, unspecified and nonspecific codes should be avoided. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. 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. You start saving within 72 hours of joining a plan (no long waits before you qualify for discounted care!) Dr. Shannitta Bridgers is a pediatric dentist at Highland Pediatric Dental in Fayetteville, SC. Please review the plan benefit coverage documentation under the link below. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). list of CPT or HCPCS codes to only those requiring PA, please check the box labelled Include only CPT or HCPCS codes where PA is required?. 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. If your patient has primary Medicare coverage outside of Aetna Better Health Premier Plan, please call the Medicare plan for benefits and authorization requirements. The online provider directory is updateddaily. 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. Pharmacy prior auth phone number: 1-855-221-5656. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Working with providers, our advanced care management techniques help increase quality, improve efficiency . Provider Search is provided solely for the personal, non-commercial use of current and prospective Aetna members and providers. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. New and revised codes are added to the CPBs as they are updated. Street Address: . Aetna Better Health of Illinois 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. If you are in New Jersey, check your status by going to the Aetna Assure Premier Plus provider search page. Dentists and dental office professionals, log in to Aetna Dental to handle claims, find forms, stay ahead of policy changes and more. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Visit our Medicare page for more DSNP resources, including cost-share information. Enter your location by address, city or zip code. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). We welcome . Used with express permission. You will receive the discount off the providers usual and customary fees when you pay. Future changes to CPT or Healthcare Common Procedure Coding System (HCPCS) codes that require PA will be communicated by Aetna Better Health Premier Plan in writing and on the homepage of Aetna Better Healths secure web portal. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 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. General Dentists: provide all the services you need to maintain healthy teeth and gums. Each main plan type has more than one subtype. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Links to various non-Aetna sites are provided for your convenience only. 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. We encourage you to check with your participating provider prior to beginning treatment. Access2Care performs transportation management services on behalf of Aetna Better Health. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Were expanding our DSNP program into more markets for 2022. 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. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Unlisted, unspecified and nonspecific codes should be avoided. When billing, you must use the most appropriate code as of the effective date of the submission. Best viewed in Microsoft Internet Explorer 6 and higher, resolution 1280x800. Find a Dentist. When making an appointment, please be sure your provider offers all services you may need, Avsis Incorporated and Avsis Third Party Administrators, Inc. (Avsis), are wholly owned subsidiaries of Guardian. No fee schedules, basic unit, relative values or related listings are included in CPT. Unrivaled access to care in 200+ countries and territories around the world. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Go to the American Medical Association Web site. Request an Office Transfer. and you keep saving there is no maximum annual spending limit! 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. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Members must choose a PCP* to guide their treatment and coordinate all specialist care which all takes place in a quality network to keep costs in check. Others have four tiers, three tiers or two tiers. Youll find these doctors with the label Quality Care, Effective , https://www.aetna.com/individuals-families/find-a-doctor.html, North country health care university flagstaff, Jps health network schedule appointments, Health care information system examples, 2021 health-improve.org. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). This Aetna provider directory includes all Aetna participating providers, including both medical providers and dental providers. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM.
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