Behavioral Health Precertification Guide for Aetna

This guide provides essential information for healthcare providers regarding the behavioral health precertification process for patients enrolled in Aetna health plans, effective August 1, 2024. It outlines the procedures for obtaining prior authorization, also known as precertification, for various behavioral health services. The document serves as a reference for Current Procedural Terminology (CPT) codes associated with services, programs, and prescriptions that require approval for coverage. It emphasizes the importance of submitting complete precertification requests to avoid delays or denials of coverage. The guide includes specific instructions for submitting requests online through the Availity provider portal and details the clinical review process that follows submission. Additionally, it provides information about the applicability of precertification requirements across different Aetna plans and highlights special considerations for members in Texas and those enrolled in Dual Special Needs Plans in Florida. The document also notes that the precertification list is updated regularly and encourages providers to stay informed about any changes.