Aetna Better Health of NJ allows members to receive medically necessary services and treatment by a provider not in our network (non-participating provider) when the care cannot be provided by a network provider (participating provider) and the care is prior authorized by Aetna Better Health of NJ. A non-participating provider is defined as a provider who has not entered into a contract agreement with Aetna Better Health of NJ. In these instances, Aetna Better Health of NJ will pay a percentage of Medicaid fee schedule to non-participating providers who do not have a Single Case Agreement with us.
In accordance with the NJ Medicaid Contract, non-contracted hospitals providing emergency services to Medicaid or NJ FamilyCare Members enrolled in the managed care program shall accept, as payment in full, 90% of the amounts that the non-contracted hospitals or non-participating provider of emergency services would receive from New Jersey Medicaid for the emergency services and/or any related hospitalization as if the beneficiary were enrolled in New Jersey fee-for-service Medicaid.
