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Notices and newsletters

Stay up to date on the latest news for our providers, plus find helpful resources and information.

2022 updates

2021 updates

2020 updates

Policies and procedures from the Pennsylvania Department of Human Services:
 

June 2020
 

Implementation of Electronic Visit Verification (PDF)
 

May 2020

EPSDT Program Periodicity Schedule (PDF)

Updates to Childhood Nutrition and Weight Management Services (PDF)

Archived updates

Important update: June 16, 2016
 

The Commonwealth of Pennsylvania’s Department of Human Services (DHS) intends to enforce the Provider Enrollment and Screening Provisions of the Affordable Care Act (ACA) (§ 455.414).
 

We want to make all providers aware that DHS enforcement of the provider enrollment and revalidation requirement will begin on August 28, 2017.
 

Please ensure you have met all enrollment requirements, including revalidation of your PROMISEe ID, to avoid termination from the Aetna Better Health of Pennsylvania network. 
 

Read the full provider notice (PDF) for helpful revalidation information that was previously sent to all providers earlier this year.

On January 15, 2009, the US Department of Health & Human Services issued two final rules for adoption:
 

  • An updated HIPAA X12 standard version 5010 for electronic transactions, with a compliance date of January 1, 2012. The updated format has more than 1,300 changes to the 4010 standard (with 600+ just for claims).
  • Adoption of the ICD-10 Code Sets with a compliance date in October 2015 (version 5010 accommodates the ICD-10 code structure; 4010 does not).
     

Aetna Better Health met the compliance requirements for the federally mandated HIPAA 5010 version transactions for 1/1/2012 and is on track to be able to accept ICD-10-CM & PCS Codes for dates of service for October 2015.
 

Online ICD-10 resources
 

El Programa de Pago de Incentivos para Registros de Salud Electrónicos (EHR) de Medicaid fue creado por la Ley de Recuperación y Reinversión Estadounidense y es administrado por los Centros de Servicios de Medicare y Medicaid. Este programa brinda fondos a los estados para desarrollar y administrar programas de incentivos para proveedores.

On August 20, 2015, Governor Tom Wolf announced that all CHIP health insurance plans would provide enhanced benefits. The added benefits are outlined in the Affordable Care Act. These benefits take effect for all children enrolled in CHIP on December 1, 2015.
 

These changes include removing some historical benefit limits on specific services to ensure Minimal Essential Coverage (MEC) compliance for all CHIP products.
 

Some categorical benefit changes include:
 

  • Increasing vision services to include low vision items and “add-on” services such as protective coating, when medically necessary
  • Agregar selladores al paquete de beneficios dentales.
  • Eliminar los límites en la cantidad de visitas de salud del comportamiento aprobadas.
  • Aumentar los límites de visitas de rehabilitación ambulatoria a 30 visitas por modalidad, por año de beneficio (terapia física, terapia ocupacional, terapia del habla).
  • Removal of dollar limits for autism services
  • Brindar cobertura para una visita de atención médica domiciliaria cuando una paciente recibe el alta del hospital luego de un parto o de una mastectomía.

There is nothing current CHIP members need to do to get these benefits. All CHIP members will automatically receive these enhanced health benefits. Members will not receive new ID cards as the benefits are now MEC-required for all Free, Low and Full Cost CHIP products by all CHIP contractors in the Commonwealth of Pennsylvania.

We are pleased to inform you that your Quality Measurement Reports are now available online. You may now access year-to-date reports through the Provider Reports Management Tool on our secure web portal.
 

Some examples of the types of reports you can access include:
 

  • Informes sobre interrupciones en la atención de HEDIS.
  • Informes de medición de pago por desempeño.

These reports serve as a guide for which Aetna Better Health members need care and where your practice stands regarding Pay-for-Quality incentives for the care you provide. Be sure you receive credit for the care you provide to Aetna Better Health members. Pay-for-Quality is awarded for care captured administratively through claims submissions.
 

If you have provided care that we may not have captured due to potential claims or coding issues, please contact Aetna Better Health Provider Relations at 1-866-638-1232, option 3. You can also directly contact the Quality Translator that has been sending you Gaps-in-Care Reports for assistance.
 

As a reminder, you can access up-to-date panel lists for your practices on our secure web portal. You can also upload Medical Records for HEDIS Medical Record Review.

Effective November 1, 2016, Aetna Better Health will apply our Emergency Department (ED) claims review policy to Medical Assistance and CHIP claims.

Also of interest: