The American Chiropractic Association met with Aetna regarding their auth and claims processing.
Dear Colleagues:
Yesterday, Ray Tuck, Ed Nielson and Karen Silberman met with Aetna and Magellan/NIA employees. The meeting was scheduled in response to the October 2018 letter that was jointly signed by the ACA, PCA, NYSCA, NYCC and WVCS. The meeting was productive. We discussed Aetna’s payment policies and documentation standards, data sharing for better understanding of clinical pathways, the opportunity to collaborate on model payment policies and how to build trust between chiropractors and Aetna.
Aetna shared that the majority of denials are not related to specific care delivered, but a result of documentation errors centered around incomplete descriptions of services rendered and content of notes not supporting the treatment plan. This lead to a conversation about the importance of agreeing on a clear standard of documentation requirements and how best to educate doctors. Magellan and the ACA agreed to explore collaborating on defining these standards and in the creation of a series of documentation webinars. Additionally, the group discussed one of the ACA's potential initiatives of creating a universal model payment policy that would include specific and reasonable quality care metrics to ensure access for patients. Everyone in attendance agreed that would be a great resource for all parties and would be supportive in its creation. Aetna is meeting with the APTA in March and would like to further discuss collaborative opportunities after that has occurred.
The meeting attendees include two chiropractors Robert Frank, Aetna’s Medical Director and Kathy Norman, Magellan’s Chiropractic Services Director. Additionally, two PT’s attended, Justin Clifford, Magellan’s Senior Provider Relations Manager and Hanna Hartung, Magellan’s Director of Product Innovation. We will ask Aetna to provide the same physical medicine provider balance and professional courtesy at their meeting with APTA.
Aetna and Magellan will share the outcomes of the meeting with their teams as will the ACA. We will reconnect in February to update one another on our respective leadership’s support of the education and payment policy projects. In late March, Aetna will include the PT’s if appropriate.
Karen Silberman, CAE
Executive Vice President
ACA Association
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