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News & Press: Insurance/Provider

AlaskaCare Retiree 2020 Claims Denials

Wednesday, February 5, 2020   (0 Comments)
Posted by: Sheri Ryan
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ACS is getting statewide reports that offices are receiving claim denials from Aetna for spinal manipulation provided for AlaskaCare patients - specifically for State of Alaska retirees. EOBs have the reason - "Decision made in Clinical Claim Review - W68". When contacted, Aetna is stating that until the previous denial is lifted, the patient can not receive spinal manipulation with therapeutic modalities.

This seems contradictory to our understanding of what the Division of Retirement and Benefits shared with ACS through the Chiropractic Community Meetings. See 12/5/2019 News Release on the ACS website.

What is ACS doing? We have requested that this situation be evaluated by the DRB immediately and added to the February Chiropractic Community Meeting for discussion. The DRB is monitoring the Aetna hotline email address to evaluate how widespread the situation is. These claim denials appear to be occurring regardless if patients are presenting with new injury, new condition, and/or new treatment plan. The new terms with the AlaskaCare retiree policy took effect 01/01/2020 but the same barriers to chiropractic care for the AlaskaCare State of Alaska retiree with Aetna seem to exist.

What can YOUR Office do?

  • Log the situation with the Aetna hotline mail address - - monitored by the DRB. Download the AlaskaCare Chiropractic Provider Services Announcement and follow the process to log your claim denial.We need to let the DRB know how widespread the situation is and the only way to do that is to get examples of these claims into their system!

  • Send a copy of the redacted claim denial to ACS for tracking. Email to - Subject = AlaskaCare Retiree Claim Denial 2020

  • Follow through on available Aetna Provider reconsideration and appeal processes.

  • Educate your patients on their appeal rights and strongly encourage THEM to follow through on the appeal process. Patients have more extensive appeal rights than providers.Here's a brochure to assist retirees. AlaskaCare Retiree Health Plan Appeal Guide - -> and the AlaskaCare Retiree Health Plan Booklet 2020

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