Improving our customer service to you We improved our customer service model to give you better service. When you need to reach us, just use the options below instead of calling your local network contact. These options are easy to use and will save you time.

First, visit the Electronic Transaction Tools page on our website

• These tools will help you with administrative tasks, like electronic patient referrals and e-prescribing.

• Email us via the “contact” link on the site, if you can’t find what you need and want to reach us.

Or, log into our secure provider website on NaviNet® Here you can:

• Get information on benefits, referrals and claims

• Use our provider payment estimator and submit professional claims

• Update your registration, billing and user profile information easily

• See your patients’ personal health records to help you better coordinate their care

Our automated phone system is always available With our automated system, you can find out if a procedure needs precertification, get a patient’s copay or claims status. Call us at:

• 1-800-624-0756 for HMO-based and Medicare Advantage plans.

• 1-888-MDAetna (1-888-632-3862) for all other plans.

If you can’t resolve your issue through the automated system, our provider service center staff can help.

48.22.800.1 K (3/16)www.aetna.com

Spring 2016 • Volume 11, Issue 1

Aetna Behavioral Health InsightsTM

Behavioral Health newsletter

Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutions

Inside this issue

Improving our customer service 1

Reader survey 2

Update your office’s data online 2

New behavioral health CE programs 3

2016 Medicare compliance 3

OfficeLink newsletter 3

EAP CORNER

EAP seminar presenters wanted 4

GET CONNECTED! Electronic claims submission 5

Digital member ID cards 5

PROVIDER QUALITY COUNTS

HEDIS® highlight 6

New opioid risk screening program 7

Clinical practice guidelines 7

Member Rights and Responsibilities 8

Provider manuals and patient rights 8

STATE NEWS

AZ – Aetna LeapSM plans update 9

Carolinas – Aetna LeapSM plans update 10

Southeastern PA – Aetna LeapSM plans update 11

Northern VA – Aetna LeapSM plans update 12

CONTACT US Cont. on page 2

2 Aetna Behavioral Health Insights

Improving our customer service to you (continued)

Our education site at www.AetnaEducation.com is also a great resourceThis site offers:

• User-friendly navigation and search

• Free continuing medical education/continuing education courses (CME/CE)

• A variety of office staff courses to help ease administration

• “Share with a colleague” functionality

• Online, live webinars and recorded events

• Valuable reference tools to make your job easier, and much more

Thanks for responding to our reader survey!We want to make the Aetna Behavioral Health Insights newsletter the best it can be. Thanks for sharing your experiences as a reader through our survey. Your feedback will help us feature more of the kinds of articles you’d like to see in the future.

The good news is:

• 91.3 percent of readers say our articles are just the right length

• 95.6 percent believe the newsletter is easy to read

Look for articles about your requested topics in upcoming issues of Insights.

Update your office’s demographic data online If you need to change or update your office’s demographic information — new email addresses, or a new mailing address, phone or fax numbers — you can do so through our secure provider website.*

Our secure site lets you validate the information you submit. It also ensures that unauthorized individuals aren’t submitting incorrect information about your office or facility.

You’ll need to register for our secure websiteTo use the secure website you must first register. Registration is easy. Once registered, you’ll also be able to submit claims transactions, check member eligibility and benefits and even verify referrals.

You may see a letter from us about your dataWe may send you a letter asking you to validate your demographic information. The letter will show the current information we have on file for you. We ask that you respond to the letter with any updates as soon as you can.

*You’ll need to call our Provider Service Center at 1-888-632-3862 for TIN changes/updates.

3 SPRING 2016

Check out new behavioral health CEs on our education site Our education site for health care professionals is the no-cost single source of learning opportunities for providers like you. Check out these new behavioral health continuing education (CE) programs at www.AetnaEducation.com:

• Adherence to Prescription Medication

• Eating Disorders and Treatment Updates

• Psychopharmacology

• Federal Mental Health Parity & Addiction Equity Act - A Compliance Overview for Clinicians

• Technologies for post-traumatic stress problems: Assisting veterans and others with PTSD

• Understanding Mental Illness: What Individuals and Families Living with the Illnesses Want Professionals to Know

Medicare compliance news for providers – action requiredIf you’re contracted with us to provide health care services for our Medicare Advantage plans, you’re considered a “First Tier Entity.” The Center for Medicare & Medicaid Services (CMS) requires that you fulfill specific Medicare compliance program requirements. We describe those requirements in our First Tier, Downstream, and Related Entities (“FDR”) Medicare Compliance Program Guide (FDR Guide).

You should review our FDR Guide and make sure you have processes in place to comply with all the requirements. You can find the FDR Guide on www.AetnaEducation.com.

Complete your attestation now and avoid changes in participation statusEach year you must confirm you’ve met the Medicare compliance program requirements by completing an attestation. One attestation meets both Aetna and Coventry compliance obligations. Not complying could impact your participation status.

The attestation is available on NaviNet. If you’ve never used NaviNet, log in or register today:

• New users: Register for NaviNet

• Existing users: Log in to NaviNet

Once you log in, visit the Aetna Plan Central. Hover over “Compliance Reporting” (on the left) and then click “Medicare Attestation.”

We’re here to helpIf you need more information, you can find educational content on www.AetnaEducation.com by typing “FDR” in the search box. Or, you can call 1-800-624-0756.

You can disregard this notice if you’ve completed your 2016 Attestation.

Don’t forget to read OfficeLinkAetna OfficeLink Updates™ — our quarterly newsletter for medical providers and other health care professionals — may also offer articles useful to behavioral health practitioners. Get this publication on our website.

Consider becoming an Aetna Resources for Living seminar presenterAetna Resources For Living, our EAP, offers a broad range of seminars to our customers. Categories include EAP service orientation, daily living, health and well-being and professional development.

These seminars are delivered both face to face and virtually at our customers’ locations nationwide. Our training network includes behavioral health and training professionals with varied expertise and backgrounds.

We invite qualified professionals to join our educator network

We’re looking to expand our educator network. Qualifications for trainers include:

• A minimum of two years of training experience

• Ability to adapt to a wide range of demographics

• A minimum of two years working with an EAP

If you’re interested in becoming a part of this educator network email us at eapseminarrequest@rfl.com. One of our staff members will reach out to set up an interview.

EAP CORNER

Aetna Behavioral Health Insights4

5 SPRING 2016

Get paid faster by submitting all of your claims electronicallySubmitting all of your Aetna claims electronically means you’ll receive faster payments. Don’t have billing software? Register for our free secure provider website on NaviNet and start submitting your professional claims for free!

See how much you can save by doing all business with us electronicallyDoing business with us electronically means more than just sending us your claims electronically. You can also check your patients’ eligibility and request precertification online. When you send us electronic transactions, it saves you time and money. Try our Provider Electronic Savings Calculator to see how much you can save by doing all of your business with us electronically!

Questions?Send us any questions by clicking on “Contact us online” then on “Submit a medical or behavioral health question or comment.”

Member ID card on smartphone is validIf Aetna members show you their ID card on their smartphone or other mobile device, your office or facility should accept that as valid proof of insurance coverage.

The digital ID card is an electronic version of the member’s ID card. It still allows you to easily get all of the information you need.

You should expect to see an increasing number of members using this technology in the future. Of course, many members will continue to use ID cards in plastic or paper formats.

GET CONNECTED!

Aetna Behavioral Health Insights6

HEDIS® highlight

Follow-Up After Hospitalization for mental illness (FUH)Approximately one in four adults in the U.S. suffers from mental illness in a given year and nearly half of U.S. adults will develop at least one mental illness in their lifetime.1 2 People with a mental illness are less likely to use medical care and to follow treatment plans.2 Proper follow-up care can improve health outcomes for adults and children.

HEDIS3 is a long-standing industry tool used to measure health plan performance on a wide range of important health care issues. The FUH measure looks at the percentage of discharges for patients hospitalized for mental health treatment who have had an outpatient, intensive outpatient or partial hospitalization visit post discharge. Two rates are reported. Both look at the percentage of inpatient discharges where the patient received follow-up behavioral health care:

• Within 7 days of discharge

• Within 30 days of discharge

Why 7-day follow-up?Effective, timely follow-up care after discharge from a psychiatric hospitalization is vital. It can help reduce the risk of suicide, decrease repeat hospitalizations and identify patients in need of more interventions before they reach a crisis point.

You can help improve patient follow-up care:• Plan for the patient discharge from the onset of services.

• Communicate the importance of follow-up care to patients and their support network.

• Coordinate aftercare with outpatient providers.

• Schedule the outpatient appointment before discharge and include the appointment information on the discharge instructions.

Online resources for you • National Quality Measures Clearinghouse

• Articles on the risk of suicide and hospital readmission for patients discharged from an inpatient mental health stay

• Hospital tools for discharge planning

PROVIDER QUALITY COUNTS

1National Alliance on Mental Illness. 2011. “Mental Illness: What is Mental Illness: Mental Illness Facts.” http://www.nami.org/template.cfm?section=about_mental_illness (January, 2016).

2Centers for Disease Control and Prevention. Updated September 1, 2011. CDC Mental Illness Surveillance. “CDC Report: Mental Illness Surveillance Among Adults in the United States.” http://www.cdc.gov/mentalhealthsurveillance/fact_sheet.html (January, 2016).

3The Healthcare Effectiveness Data and Information Set (HEDIS®) represents the leading set of standardized healthcare performance measures. Designed and maintained by the National Committee for Quality Assurance (NCQA), HEDIS allows performance comparisons of significant public health issues among competing health plans.

7 SPRING 2016

New screening program aims to address risk of opioid overdose Our Aetna behavioral health clinicians are screening behavioral health cases to identify patients at risk of death due to opioid overdose. We started this Opioid Overdose Risk Screening (OORS) Program in January 2016. We consider any patient with a diagnosis of opioid dependence to be at risk.

How you can helpWe recommend that providers consider naloxone, a rescue medication that reverses the effects of an opioid overdose, as part of the patient’s ongoing treatment plan when opioid dependence is diagnosed. Countering the effects of overdose in the event of relapse allows the patient to continue the recovery process. Research has shown that the availability of naloxone does not inhibit recovery by providing a “safety net” for ongoing use.

Other elements supporting this potentially life-saving intervention include giving information to patients and their family/support network about:

• Signs of overdose

• How to administer naloxone as a rescue medication

Coverage of naloxone rescue kits varies by individual plans. You can verify this by calling the number on your patient’s ID card.

What you need to know about the opioid problemThe epidemic rise in prescription opioid and heroin abuse has meant a corresponding rise in deaths due to opioid overdose. It’s estimated that in 2013 almost 2 million people in the US were abusing prescription opioids. An additional half million suffered from heroin use disorder.4 Dependence frequently begins through the misuse of opioids prescribed to manage pain. As dependence develops, or as prescriptions are cut back or stopped, people may resort to cheaper and more dangerous drug choices like heroin.

Naloxone, a life-saving solutionNaloxone saves lives. In 2014 there were nearly 20,000 opioid overdose deaths from prescription pain relievers, and 10,000 more from heroin overdose. The Centers for Disease Control and Prevention estimates that over 10,000 opioid overdoses were reversed nationwide between 1996 and 2010, in response to emergency naloxone administration. Naloxone is effective against all forms of opioid overdose.

Resources to help you and your patients• Centers for Disease Control and Prevention:

Providing naloxone to lay persons

• SAMHSA: Opioid overdose toolkit

Clinical Practice Guidelines help you care for your patientsThe National Committee for Quality Assurance (NCQA) requires health plans to regularly inform practitioners about the availability of Clinical Practice Guidelines (CPGs). The following Behavioral Health CPGs are based on nationally recognized recommendations and peer-reviewed medical literature. They’re posted on our secure provider website. Go to Plan Central/Aetna Health Plan/Support Center/Clinical Resources/Clinical Practice Guidelines. Or, click on the links below:

Helping Patients Who Drink Too Much

Treating Patients With Major Depressive Disorder

ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

Adopted 2/16

Adopted 2/16

Adopted 2/16

For a hard copy of a specific CPG call our Provider Service Center at 1-888-632-3862.

4Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. (2014)

8 Aetna Behavioral Health Insights

Member Rights and Responsibilities are available online Our Member Rights and Responsibilities are available online on our public website at www.aetna.com in the Individuals & Families section under Rights & Resources on the Your Rights page.

For a copy of Aetna’s Member Rights and Responsibilities Statement call 1-888-632-3862.

Provider Manuals include information about patient rightsOur Office Manual for Health Care Professionals and our Behavioral Health Provider Manual available on our public website at www.aetna.com. They include information on member rights and responsibilities and nondiscrimination.

All participating physicians and behavioral health practitioners should have a documented non-discrimination policy. Federal and state laws prohibit discrimination in the treatment of patients on the basis of race, ethnicity, national origin, religion, sex, age, mental or physical disability, medical condition, sexual orientation, claims experience, medical history, evidence of insurability (including conditions arising out of acts of domestic violence), genetic information or source of payment.

Patient rights under ADAAll participating physicians, behavioral health practitioners and health care professionals may also have an obligation under the Federal Americans with Disabilities Act (ADA) to provide physical access to their offices and reasonable accommodations for patients and employees with disabilities. If you don’t have Internet access, call our Provider Service Center for a paper copy of these manuals.

9 SPRING 2016

STATE NEWS

ARIZONAAetna LeapSM plan members have digital ID cards On January 1, 2016, we launched our new Individual plans (Aetna Leap). Refer to the December 2015 article.

Tips to knowAs more of these members come to your office with a digital ID card, here are some tips to remember:

• You can check eligibility on our secure provider website. And soon, you’ll be able to view the member’s ID card on our secure site as well.

• Members may use a smartphone to show you a digital copy of their card.

• They may also show you a plastic or self-printed copy of their card.

• If the member doesn’t have a digital image or paper copy, use the member name/date of birth to look up.

• All ID card formats (digital, paper, plastic) are valid.

Checking eligibility• If your patients ask whether you accept Aetna, first

ask what plan they have. Then, check to make sure you participate with that specific plan via our provider online referral directory.

• When submitting eligibility inquiries, you must use one of the following search options:

- Member name/date of birth

- Member ID/date of birth (using the patient’s 12-digit ID listed on the ID card)

- Member ID/member name (using the patient’s 12-digit ID listed on the ID card)

We’re here to help you and your patients• If you have questions or need more information, call us at

1-888-MDAetna (1-888-632-3862).

• If your patients have questions, they can call 1-844-241-0208.

Need more information? Check out our Quick reference guide. Search for “leap.”

10 Aetna Behavioral Health Insights

CAROLINASAetna LeapSM plan members have digital ID cards; Rite-Aid® is now in networkOn January 1, 2016, we launched our new Individual plans (Aetna Leap). Refer to the December 2015 article.

Tips to knowAs more of these members come to your office with a digital ID card, here are some tips to remember:

• You can check eligibility on our secure provider website. And soon, you’ll be able to view the member’s ID card on our secure site as well.

• Members may use a smartphone to show you a digital copy of their card.

• They may also show you a plastic or self-printed copy of their card.

• If the member doesn’t have a digital image or paper copy, use the member name/date of birth to look up.

• All ID card formats (digital, paper, plastic) are valid.

Checking eligibility• If your patients ask whether you accept Aetna, first

ask what plan they have. Then, check to make sure you participate with that specific plan via our provider online referral directory.

• When submitting eligibility inquiries, you must use one of the following search options:

- Member name/date of birth

- Member ID/date of birth (using the patient’s 12-digit ID listed on the ID card)

- Member ID/member name (using the patient’s 12-digit ID listed on the ID card)

Pharmacy updateRite Aid pharmacies will now be in network for members in Aetna Leap plans.

We’re here to help you and your patients• If you have questions or need more information, call us at

1-888-MDAetna(1-888-632-3862).

• If your patients have questions, they can call 1-844-241-0208.

Need more information? Check out our Quick reference guide. Search for “leap.”

11 SPRING 2016

SOUTHEASTERN PENNSYLVANIAAetna LeapSM plan members have digital ID cardsOn January 1, 2016, we launched our new Individual plans (Aetna Leap). Refer to the December 2015 article.

Tips to knowAs more of these members come to your office with a digital ID card, here are some tips to remember:

• You can check eligibility on our secure provider website. And soon, you’ll be able to view the member’s ID card on our secure site as well.

• Members may use a smartphone to show you a digital copy of their card.

• They may also show you a plastic or self-printed copy of their card.

• If the member doesn’t have a digital image or paper copy, use the member name/date of birth to look up.

• All ID card formats (digital, paper, plastic) are valid.

Checking eligibility• If your patients ask whether you accept Aetna, first

ask what plan they have. Then, check to make sure you participate with that specific plan via our provider online referral directory.

• When submitting eligibility inquiries, you must use one of the following search options:

- Member name/date of birth

- Member ID/date of birth (using the patient’s 12-digit ID listed on the ID card)

- Member ID/member name (using the patient’s 12-digit ID listed on the ID card)

We’re here to help you and your patients• If you have questions or need more information, call us at

1-888-MDAetna (1-888-632-3862).

• If your patients have questions, they can call 1-844-241-0208.

Need more information? Check out our Quick reference guide. Search for “leap.”

12 Aetna Behavioral Health Insights

NORTHERN VIRGINIAInnovation Health LeapSM plan members have digital ID cards; Rite-Aid® is now in network On January 1, 2016, we launched our new Individual plans (Innovation Health Leap). Refer to the December 2015 article.

Tips to knowAs more of these members come to your office with a digital ID card, here are some tips to remember:

• You can check eligibility on our secure provider website. And soon, you’ll be able to view the member’s ID card on our secure site as well.

• Members may use a smartphone to show you a digital copy of their card.

• They may also show you a plastic or self-printed copy of their card.

• If the member doesn’t have a digital image or paper copy, use the member name/date of birth to look up.

• All ID card formats (digital, paper, plastic) are valid.

Checking eligibility• If your patients ask whether you accept Innovation Health,

first ask what plan they have. Then, check to make sure you participate with that specific plan via our Directory of Health Care Professionals.

• When submitting eligibility inquiries, you must use one of the following search options:

- Member name/date of birth

- Member ID/date of birth (using the patient’s 12-digit ID listed on the ID card)

- Member ID/member name (using the patient’s 12-digit ID listed on the ID card)

Pharmacy updateRite Aid pharmacies will now be in network for members in the Innovation Health Leap plan.

We’re here to help you and your patients• If you have questions or need more information, call us at

1-844-289-4503.

• If your patients have questions, they can also call us at the phone number above.

Need more information? Check out our Quick reference guide. Search for “leap.”

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies (Aetna). Aetna Behavioral Health refers to an internal business unit of Aetna.This material is for informational purposes only and is not medical advice. Health benefits and health insurance plans contain exclusions and limitations. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a therapist, physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change.Aetna Resources For LivingSM is the brand name used for products and services offered through the Aetna group of subsidiary companies (Aetna). The EAP is administered by Aetna Behavioral Health, LLC, Horizon Behavioral Health Services, LLC and Resources For Living, LLC. In California for Knox-Keene plans, Aetna Health of California, Inc. and Health and Human Resources Center, Inc.

www.aetna.com

©2016 Aetna Inc. 48.22.800.1 K (3/16)

For more information or if you need to contact us

Onlinewww.aetna.com

Access our secure provider website on NaviNet® available through our public website. Once there select “Health Care Professionals,” then “Log In/Register.”

Already registered? Go to https://connect.navinet.net.

To access the Aetna Behavioral Health and Employee Assistance Program page:• Log in to our secure provider website

• Choose “Aetna Support Center” from the upper-left menu

• Select “Doing Business with Aetna” followed by “Aetna Benefit Products”

By phoneAetna Behavioral Health • For general questions about

Aetna Behavioral Health call 1-888-632-3862

• For HMO-based and Medicare Advantage plans claims, benefits, eligibility, precertification, case management or demographic changes call 1-800-624-0756

• For all other plans claims, benefits, eligibility, precertification, case management or demographic changes call 1-888-MDAETNA (1-888-632-3862)

• For questions about joining the Aetna Behavioral Health network call 1-800-999-5698

Aetna Behavioral Health – Quality• Contact us at 1-800-624-0756 for

HMO-based and Medicare Advantage plans, or

• Call 1-888-632-3862 for all other plans if you:

- Have questions about our UM criteria, or if you would like a copy

- Need information about a coverage decision for one of your Aetna Behavioral Health patients

- Want to speak with one of our clinical reviewers (24 hours a day, 7 days a week)

If you have questions or want more information on provider quality efforts, you can also email our Quality Management staff at QualityImprovement2@aetna.com.

Employee Assistance Program Call Center: 1-888-238-6232

By mail Aetna Behavioral Health 1425 Union Meeting Road P.O. Box 5 Blue Bell, PA 19422