Skip to main content

Notices and newsletters

As your partner in providing care to our members, we want to make sure you have news and other info about Aetna Assure Premier Plus (HMO D-SNP). Be sure to check in often for updates.

Announcements and notices

October 10, 2024

 

Coverage change for certain antiretroviral drugs 10/10/2024 (PDF)

 

October 1, 2024

 

CLIA Provider Reminder 10/1/2024 (PDF)

 

September 5, 2024

 

Clinical Payment and Coding 12/1/2024 (PDF)

 

August 6, 2024

 

Clinical Payment and Coding 2024 update (PDF)

 

June 11, 2024

 

Provider notification for Q1 2024 (PDF)

 

New Review Process for DRG Claims

We want to inform you about an upcoming new process that will affect Aetna Assure Premier Plus. For admission dates on or after February 1, 2024, we will perform prepayment coding reviews for diagnosis-related group (DRG) claims. As always, we want to ensure the claims correctly show the services you provide to our members.

 

Helpful tips to ensure you get paid correctly


To make sure we review your claims quickly and accurately, please give us the necessary clinical information up front. After we get your claim, we will:

 

  • Review DRG facility claims based on case history
  • Check to ensure the ICD diagnosis and procedure codes show the appropriate DRG was billed

 

As always, do not hesitate to contact your Aetna Assure Premier Plus Provider Relations Representative with any questions or comments.

 

Thanks for all you do!

 

Sincerely,
Aetna Assure Premier Plus

 

January 9, 2023

 

Clinical Payment and Coding 2024 Update (PDF)

 

November 29, 2023

 

NJ  FamilyCare Trainings (PDF)

 

November 20, 2023

 

Cardiac Codes (PDF)

 

October 6, 2023

 

Genetic Codes (PDF)

 

October 4, 2023

 

Lab NCDs and Precertification Optimization (PDF)

 

The State of New Jersey's Electronic Visit Verification team has scheduled two training sessions related to phase 2 implementation for cohorts 1 and 2 for home health providers

 

August 24, 2023 3:00-4:00 PM Webinar: EVV Phase 2 Provider Training Session 1

 

You are invited to a Zoom webinar.

 

When: Aug 24, 2023 03:00 PM Eastern Time (US and Canada)

Topic: EVV | DMAHS Phase 2 Provider Training Session 1 of 2

 

Register in advance for this webinar:

https://us02web.zoom.us/webinar/register/WN_pGY17SjESKKl4maBJZuTlw

 

or

 

September 14, 2023 3:00-4:00 PM Webinar: EVV Phase 2 Provider Training Session 2

 

You are invited to a Zoom webinar.

 

When: Sep 14, 2023 03:00 PM Eastern Time (US and Canada)

Topic: EVV | DMAHS Phase 2 Provider Training Session 2 of 2

 

Register in advance for this webinar:

https://us02web.zoom.us/webinar/register/WN__4RT7lIMShuWJh6mlHVhvw

 

After registering, you will receive a confirmation email containing information about joining the webinar.

 

July 25, 2023 - Availity Promotional Flyer (PDF)

 

July 18, 2023 - Precertification Optimization July Update (PDF)

 

June 5, 2023Covid Non-Covered Services (PDF)

 

May 10, 2023COVID-19 PHE Unwinding Liberalizations (PDF)

 

April 6, 2023Precertification Optimization 06/30/2023 (PDF)

 

March 24, 2023New Fraud, Waste, and Abuse Penalties and Reporting (PDF)

 

March 1, 2023 - EFT and ERA Program Update (PDF)

 

February 2, 2023Clinical Payment, Coding and Policy Changes, eff. 3/1/2023 (PDF)

 

January 4, 2023Prior Authorization Waiver Notification (PDF)

 

November 11, 2022Hospital Acquired Conditions Notice (PDF)

 

October 1, 2022Address Changes (PDF)

 

August 30, 2022 Precertification Optimization removal (PDF)

 

August 17, 2022 - NJ Assistance Request on the Credentialing Performance Committee (PDF)

 

July 15, 2022Precertification Optimization Notice 3rd Update (PDF)

 

June 7, 2022 - Duals Precertification Optimization Add (PDF)

 

May 20, 2022Provider Onboarding and Go-Live dates for Phase 2 (PDF)

 

April 27, 2022 -COE Provider notification - Precertification Optimization (PDF)

 

October 22, 2021 PCA Agency EVV Refresher Training (PDF) and training video

 

July 6, 2021 Notice to personal care assistant, assisted living facilities, comprehensive personal care homes and assisted living programs

 

The New Jersey Fiscal Year 2022 budget has increased several rates for these services. Here are the state-mandated reimbursement rates:

 

  • Medical day care (adult day health services): $86.10 per diem
  • Personal care assistant (PCA): $22.00 per hour
  • Assisted living facilities: $87.00 per day
  • Comprehensive personal care homes: $77.00 per day
  • Assisted living programs: $67.00 per day

 

We’ll update our payment system to include the new rates and retroactively adjust any impacted claim payments for dates of service on or after July 1, 2021. We’ll also reprocess based on claims already submitted, so you don’t need to submit claims.

 


 

June 2021 EVV Billing Training for Aetna Better Health of New Jersey and Aetna Assure Premier Plus (HMO D-SNP)

 

 


 

EVV Billing Training for Aetna Better Health and Aetna Assure Premier Plus (HMO D-SNP) PCA providers and EVV technical contacts

 

May 22, 2021, Aetna Better Health of  New Jersey and Aetna Assure Premier Plus (HMO D-SNP) provided PCA Agency training-billing through HHAx and Readiness for July 1,  2021, Compliance date.  Training PDF and Video.

The next session will be held June 10, 2021 from 1:00 pm to 2:30 pm. A calendar invite has been sent to all PCA providers.  If you need additional information, please email Joseph Manger, ABHNJ COO at: MangerJ@Aetna.com

 


 

Upgrades to the Provider Portal

Prior Authorization Fax Number Update

CMS NEWS: CMS Takes Action to Protect Integrity of COVID-19 Testing

Medicare Outpatient Obeservation Notice Requirement (PDF)

Also of interest: