When it comes to Aetna and insurers, what association pushes back? PCA, of course…

In the past 2 weeks, PCA was advised by several members of an emerging treatment issue with Aetna.

The Bottom Line– Aetna was denying ultrasounds when done on the same day as e-stim. PCA forwarded questions to the Aetna/ NIA team we’ve been conversing with over the past 7 months and this morning (12-5) received the following response from Jennifer Cross-Hennigan, Aetna’s Senior Director, National Vendor Programs:

  • “Aetna did have a revision to this CPB on 10/28/18 and the claim edits should have only applied to the diabetic diagnosis codes. Unfortunately the edit did not limit it by diagnosis code correctly.
  • We have a system fix going into place on 12/16/18 to correct this issue. Aetna will then pull a claim report of all claims that denied in error and have those claims reworked. We expect that rework to be finalized by mid-February at the latest.
  • We apologize for this inconvenience but appreciate you advising so we were able to root cause and correct this issue.”