Precertification Guide for Aetna Health Plans

This document is a guide for healthcare providers regarding the precertification process for patients enrolled in Aetna health plans, effective May 1, 2024. It outlines the procedures for submitting precertification requests, also known as prior authorization or prior approval. The guide 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 requests at least two weeks in advance and provides details on how to submit requests through the Availity provider portal. The document includes specific information about services that require precertification, including inpatient confinements and certain elective procedures, and clarifies that approvals are valid for six months unless otherwise stated. Additionally, it notes that the precertification process may vary based on the member's plan and includes contact information for inquiries. Overall, it serves as a comprehensive resource for understanding Aetna's precertification requirements.