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Aetna timely filing limit 201612/5/2023 ![]() ![]() ![]() Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Members should discuss any matters related to their coverage or condition with their treating provider.Įach benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Treating providers are solely responsible for medical advice and treatment of members. The ABA Medical Necessity Guide does not constitute medical advice. The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. Aetna will review the additional information along with the original submission and render a determination.Īetna will review the request and render a determination within Missouri statutory time frames.īy clicking on “I Accept”, I acknowledge and accept that: Aetna will review the additional information along with the original submission and render a determination.Īfter the member has been discharged from an acute inpatient event and an adverse determination was issued due to lack of clinical information to support medical necessity, and clinical information is received within five (5) business days of hospital discharge but prior to peer-to-peer review or appeal request. While the member is receiving ongoing concurrent inpatient or ambulatory services, or within five (5) days of termination of these services. ![]() Aetna will review the additional information along with the original submission as a new precertification request. When received more than 14 days from the date of the denial letter for services that have not yet started and the missing information is received within six (6) months of the date of the denial letter. ![]()
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