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Aetna Advantage plans provide dental benefits through either the Aetna network or direct member reimbursement (DMR). This online tool can help a person find providers that accept their Advantage plan.
Aetna Inc. (/ ˈ ɛ t n ə / ET-nə) is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare.
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The IPA assembles care providers in self-directed groups within a geographic region to invent and implement health improvement solutions, form collaborative efforts among care providers to implement these programs, and exert political influence upward within the community to effect positive change. [citation needed]
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
For example, if patients stay in a network of providers and seeks a referral to use a specialist, they may have a copayment only. However, if they use an out of network provider but do not seek a referral, they will pay more. POS plans are becoming more popular because they offer more flexibility and freedom of choice than standard HMOs.
GEHA (Government Employees Health Association) is a self-insured, not-for-profit association providing medical and dental plans to federal employees and retirees and their families through the Federal Employees Health Benefits program and the Federal Employees Dental and Vision Insurance Program (FEDVIP).
In addition, payment to dental professionals is based on the CDT code(s) reported on the ADA Claim Form, so using the most current codes helps to maximize reimbursement and minimize audit liability. [6] In the near future, dental professionals will be required to use diagnosis codes in support of the procedures and services they provide.
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related to: aetna dental referral form pdf free printable