Winter Edition - Vol. 15 No. 1
As you know, approximately 175,000 retired state workers and school employees have been moved to Aetna Medicare Advantage plans that will be effective Jan. 1, 2019. Aetna had sent letters to providers with a breakdown of the claim and contact information for these plans. In case you missed or did not receive the letter, the information is below.
As previously reported, Aetna will be implementing a new pre-authorization program being managed by National Imaging Associates (NIA) beginning January 1st. The process will be required for in-network providers on fully funded policies only. For claims submitted on or after January 1st pre-authorization will be required in order for payment to be issued.
On Oct. 2, 2018, we advised that many members had received denials from Aetna for lack of pre-authorization of care. We immediately approached Aetna regarding this as the new pre-authorization program is not set to begin here in New Jersey until Jan. 1, 2019
As previously reported, Aetna’s contract with Triad/eviCore is expiring on Dec. 31, 2018. A vendor called National Imaging Associates (NIA) will be managing a new pre-authorization program immediately following the Triad contract expiration, starting Jan. 1, 2019.