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News & Press: Insurance/Provider

AlaskaCare Update 12/5/2019

Thursday, December 5, 2019   (0 Comments)
Posted by: Sheri Ryan
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ALASKACARE + AETNA

Cotiviti Claims Re-Processing Details

This is the update to the 11/29/2019 ACS communication regarding the Division of Retirement and Benefits quarterly meeting on 11/18/2019. Thank you for being patient as we waited for further information from the State of Alaska. Here's the OFFICIAL DETAILS on the meeting from the DRB!!!


Cotiviti Claim Edit Reprocessing -The Division announced it directed Aetna to reprocess AlaskaCare claims impacted by the Cotiviti edits effective April 18, 2019 through their discontinuation on July 1, 2019. Aetna’s goal is to reprocess them in the next 90 days with a target completion date by the end of February.There is no action that providers need to take for claims already submitted, the claims will be reprocessed automatically.A reminder that the Cotiviti edits are suppressed but claims are still subject to plan rules and medical necessity.

  • No immediate action from providers or members is required for claims that have already been submitted and denied.
  • AlaskaCare claims with a DOS between April 19, 2019 and July 1, 2019 that have not been submitted should be sent directly to Daniel Dudley at dudleyd@aetna.com.

This change does not apply to:

  • Non-AlaskaCare Aetna member claims from any other plan sponsor or employer.
  • Claims denied resulting from standard Aetna claims processing.If a claim is reprocessed, the claim could still trigger a standard Aetna edit, benefit rule or medical necessity review.

It is anticipated that all impacted claims submitted by Dec. 15th, 2019 will be reprocessed within 90 days.


Provider Support-The time frame for the provider Aetna Point of Contact email box has been extended. The end date has been changed from Nov 15th, 2019 to February 29th, 2020. Download the AlaskaCare Chiropractic Provider Services Announcement.


Retiree Plan- Medical Necessity Review Timing -Reminder that starting January 1, 2020, the trigger for medical necessity after 25 visits will be reset on an annual basis. This should help reduce the administrative burden on claim processing.This change will be for all spinal manipulations.

DRB wants to check in 60-90 days later to make sure the change is having the anticipated positive impact.


If you have questions or concerns, please feel free to call ACS at (907) 903-1350.

Best regards,

Sheri Ryan| Chief Operating Officer

Alaska Chiropractic Society
550 E. Tudor Rd., Suite 202 | Anchorage, AK 99503

Direct/Mobile: (907) 903-1350 | Fax: (907) 770-3790

sryan@akchiro.org |Facebook|Twitter|Website.

 

Have a question you'd like help with? Try the Alaska Chiropractic Society Members Group NOW AVAILABLEon Facebook!Request on FB toJOIN NOWLIKE, FOLLOW, SEE FIRST on Facebook!

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Alaska Chiropractic Society, PO Box 111507, Anchorage, AK  99511-1507 
    
Phone: (907) 903-1350   Fax:  (907) 770-3790   Email:  info@akchiro.org