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Value Added Benefits
Aetna Better Health of Ohio members are eligible for certain value added benefits when they opt to receive both their Medicare and Medicaid coverage through our plan. These benefits are not only nice perks that neither Medicare nor Medicaid standardly cover, but are also valuable contributions to the members' overall health and wellness.
Sometimes our members may not be aware of one our more of these benefits that they are eligible to receive. If you encounter one of our members who may have a difficult time finding transportation to their appointments, does not have reliable internet or phone access, could benefit from getting more physical activity in their lives, or simply need routine dental work let them know their health plan may have a no-cost solution for them.
Our fully covered Medicare-Medicaid plan members receive:
 Transportation - Up to 30 round trips, or 60 one-way trips annually.
 Federal Free Cell Phone Program - A no-cost smartphone with talk time, data, and unlimited texting.
 Silver Sneakers - No-cost access to exercise equipment, group fitness classes, social events, and more at participating gyms and fitness centers across the country.
 Over the Counter Items - $50 per month to purchase over-the-counter items at participating retailers.
 Dental - Oral exams, cleaning, fluoride treatment and x-rays twice per year for members 21 and older.
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Skilled Nursing Facility - Direct Schedule with Logisticare
Aetna Better Health of Ohio is excited to announce that we have partnered with LogistiCare to provide a new way for Skilled Nursing Facilities to schedule transportation for our members by utilizing a designated transportation provider within LogistiCare's provider network.
Through this program, the SNF will be able to schedule all of the Aetna Better Health of Ohio members residing in your facility transportation needs by working directly with the designated transportation provider in your area.
If your facility is interested in participating in this program, please contact LogistiCare at 866-910-7680 and let LogistiCare know your interest in participating in the SNF post-authorization program with Aetna. LogistiCare will provide an approved list of transportation providers for your area, in addition to additional details around the specifics of the program.
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Breast Cancer and Colorectal Cancer Screenings
Cancer screenings are an integral part of healthcare. Screenings provide the opportunity to detect cancer before it causes any symptoms. Early detection is the best way to increase a patient's chance of survival.
Breast cancer and colorectal cancer screenings are Healthcare Effectiveness Data and Information Set (HEDIS®) measures that Aetna Better Health of Ohio is evaluated on yearly. Based on HEDIS 2017 data, the breast cancer screening rate was 58.7% and the colorectal cancer screening rate was 42.1% but the goal rates were 66% and 67.7%, respectively. With education and effective communication from the provider, the member can learn why these screenings are important.
A patient's annual visit is the opportune time to talk to them about the appropriate cancer screenings for their age and gender. Providers can also hand out pamphlets that can supplement the discussion. Encourage the member to ask questions and help the members address and remove any barriers they may encounter when it comes to scheduling or preparing for a screening. Having this conversation can ease the patient's worries and concerns about the screening process.
Screenings can help save lives. Have the dialogue with the patient and relay to them the urgency and importance of having breast cancer and colorectal cancer screenings at regular intervals.
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Diabetic Retinopathy
According to the CDC, diabetic retinopathy is the leading cause of blindness among US working-aged adults ranging from 20-74 years. Diabetes-related blindness costs the nation about $500 million annually but through education and support from providers, patients can achieve a positive outcome.
Providers can empower patients by educating them about their condition. Initially, diabetic retinopathy may not have any symptoms. As the condition progresses, patients may notice blurry vision, halos around lights, loss of central and color vision as well as spots that float in their vision.
Diabetic retinopathy may not have symptoms early on so screening is very important. Encourage your patients to schedule an annual comprehensive dilated eye exam with an ophthalmologist. Early diagnosis and timely treatment reduce the risk of vision loss.
Screening and treatment are paramount but a lack of transportation, financial challenges or limited access to eye care professionals could keep a patient from scheduling an appointment. Support the patient by providing resources that could help remove these barriers. You can refer them to their Aetna care manager to help them remove these barriers.
Help your patients look to the future by reminding them about the importance of diabetic retinopathy screening during their annual visits.
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Hypertension
Aetna Better Health of Ohio (ABHO) has 7800 members that have hypertension as a primary or secondary diagnosis. Chances are, the ABHO members you see at your practice have been diagnosed by you or another provider as having high blood pressure.
Managing hypertension can be daunting for the member. What can they eat? How much activity should they get? What is considered a compliant blood pressure? Uncertainty about their condition can lead to the member being overwhelmed and disengaged but providers can change these feelings and attitudes with some simple interventions.
Providers should see the patient 2-4 times per year to monitor the blood pressure. Take the opportunity at each visit to discuss a healthy diet and physical activity. It may also be a good time to re-assess the medication regimen as well as discuss any barriers that the member may encounter with trying to manage their high blood pressure.
With a combination of education, monitoring, and engagement, the provider and patient can work together to lower and obtain a healthy blood pressure for the member.
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There is Still Time to Sign Up For a Webinar
Aetna Better Health of Ohio is conducting a series of Provider-centered webinars focused on Provider Responsibilities, Aetna resources, and our secured Provider Portal.
If you haven't already signed up for a session do so today by using one of the links below, or visiting our website.
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Appointment Availability Standards & Timeframes
Providers are required to schedule appointments for eligible enrollees in accordance with the minimum appointment availability standards, and based on the acuity and severity of the presenting condition, in conjunction with the enrollee's past and current medical history. Our Provider Services Department will routinely monitor compliance and seek Corrective Action Plans (CAP), such as panel or referral restrictions, from providers that do not meet accessibility standard. Providers are contractually required to meet the Ohio Department of Medicaid (ODM) and the National Committee for Quality Assurance (NCQA) standards for timely access to care and services, taking into account the urgency of and the need for the services.
The table on the below shows appointment wait time standards for Primary Care Providers (PCPs), Obstetrics and Gynecologist (OB/GYNs), high volume Participating Specialist Providers (PSPs), and Mental Health Clinics and Mental Health/Substance Abuse (MH/SA) providers.
Provider Type
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Emergency Appointment Timeframe
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Urgent Appointment Timeframe
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Routine Appointment Timeframe
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Appointment Wait Time (Office Setting)
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Primary Care
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Same Day
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Within 2 calendar days
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Within 3 weeks
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No more than 60 minutes
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Specialist Care
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Immediate
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Within 2 calendar days
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Within 3 weeks
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No more than 60 minutes
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OB/GYN
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Immediate
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Within 2 calendar days |
Initial Prenatal Care
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1st Trimester: Within 3 weeks
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2nd Trimester: Within 7 calendar days
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3rd Trimester: Within 3 calendar days
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High Risk: Within 3 days
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Routine Care: Within 3 weeks
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Postpartum Care: Within 6 weeks
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Behavioral Health
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Potentially suicidal individual: immediate treatment
Non-life threatening emergency: within 6 hours
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Within 48 hours
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No more than 60 minutes
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EPSDT (Early Periodic Screening Diagnosis & Treatment)
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No more than 60 minutes
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Physical Therapy
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Within 24 hours
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Within 72 hours
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No more than 60 minutes
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Occupational Therapy
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Within 24 hours
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Within 72 hours
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No more than 60 minutes
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Sports Medicine
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Within 24 hours
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Within 72 hours
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No more than 60 minutes
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Audiology
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No more than 60 minutes
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How to Request Criteria
Aetna Better Health of Ohio's medical necessity decisions for requested medical and behavioral services are based upon medical necessity criteria and practice guidelines. The criteria and guidelines are disseminated to all affected practitioners, and/or providers, upon request.
To request criteria, call 1-855-364-0974, select option 2, and then option 4.
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HEDIS Corner
HEDIS 2018 Wrap-Up & Quality Navigator Webinars
Thank You for Contributing to a Successful HEDIS 2018!
Aetna Better Health of Ohio completed our annual Healthcare Effectiveness Data and Information Set (HEDIS) medical record collection process the first week of May. We are sincerely grateful for our dedicated provider community. We appreciate your partnership in this effort by you and your staff in your timely responses to our requests for medical records and allowing our review nurses to complete on-site appointments. We look forward to continuing to work with you for many years as we join our members in receiving the best care for better health.
In preparation for HEDIS 2019, we encourage you to participate in our free Quality Navigator monthly webinars. The goal of the webinar series is to:
- Educate on HEDIS measures
- Explore ways to cut down on the burden of medical record review and maximize administrative data capture
- Present NCQA HEDIS reporting codes that will effectively capture care
- Discuss HEDIS measures applicable to certain populations
- Open discussion to see how other providers are addressing HEDIS and barriers to care
- Strategies for improvement
- Connect you with a single point of contact at the health plan for HEDIS/Quality questions
Check your inbox for monthly invites and registration information. If you are not currently receiving the invitations and would like to start receiving them, please send via email your name and email address to your Provider Relations Liaison.
COMING SOON: You will soon have the capability to watch recorded webinars at your convenience. Stay tuned for further details. In the meantime, PowerPoint slides from the 2018 webinars to date are available at the following links:
January
February
Questions?
For HEDIS related questions contact our HEDIS Help Line at 855-750-2389.
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Member Rights and Responsibilities
As a practitioner who ensures high quality care for Aetna Better Health of Ohio members, you should be aware of the members' rights and responsibilities. Some of the rights we provide to our members are as follows:
- A right to receive information about Aetna, our services, our practitioners and providers, and member rights and responsibilities
- A right to be treated with respect and recognition of the member's dignity and right to privacy
- A right to participate with practitioners in making decisions about their health care
- A right to a candid discussion of appropriate or medically necessary treatment options, regardless of cost or benefit coverage
- A right to voice complaints or appeals about Aetna or the care we provide
- A right to make recommendations regarding Aetna's member rights and responsibilities policy
In addition, our members have the following responsibilities:
- A responsibility to supply information (to the extent possible) that Aetna and our practitioners and providers need in order to provide care
- A responsibility to follow plans and instructions for care that they have agreed to with their practitioners
- A responsibility to understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible
For a complete list of member rights and responsibilities, visit our website at www.aetnabetterhealth.com/ohio to see our Member Handbook.
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Fee Table
Providers must bill according to CMS and Medicaid guidelines. It is also the provider's responsibility to be familiar with the latest billing practices. Aetna is not responsible for instructing providers how to correctly bill for services.
Also, providers should frequently check the state's Fee Schedule & Rates website as updates are always occurring to the fee schedules for Medicaid.
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