Aetna Supports Physicians, Pharmacists, Members in H1N1 Flu Response
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HARTFORD, Conn., November 03, 2009 — Aetna (NYSE: AET) is providing free electronic roster billing for pharmacies and other non-traditional providers to use when submitting claims for the administration of the H1N1 flu vaccine. Health plan members receive coverage for H1N1 immunizations under their medical benefit, not as part of their pharmacy coverage, and typically, pharmacies are not able to bill for medical services. However, with “mass immunizers” including pharmacies, community centers, and health clinics now authorized to administer the H1N1 vaccine, Aetna has adjusted its claims processing and payment policies to accept claims for the administration of the H1N1 vaccine from these providers and facilitate the prompt and accurate payment of these claims. “Accepting roster billing is yet another example of Aetna’s continuing efforts to remove barriers to vaccination for our members, and eliminate administrative complexity that could hinder access,” said Bill Fried, MD, Aetna’s medical director heading the company’s pandemic flu response initiative. “Our goal is to support members by being flexible so they can obtain the H1N1 vaccine at a convenient location. Likewise, we are extending this flexibility to the health care professionals who are taking on the task of administering the vaccine to our members as part of the national effort to respond to the H1N1 flu pandemic.” Roster billing is a simplified process that makes it easier for mass immunizers to bill health plans in bulk by submitting a single claim with a list of health plan members they have immunized, rather than filling out separate paperwork for each individual they vaccinate. Aetna has contracted with ZirMed® to provide electronic roster billing for administration of the H1N1 vaccine. Providers will access ZirMed’s website to enroll in the program, download the Excel template roster bill, and then upload the completed rosters electronically. Pharmacies that already have a process in place with a vendor to file individual electronic medical claims may continue to do so. Providers who are unable to submit H1N1 vaccine administration claims electronically can print a paper copy of the roster bill and mail it to Aetna. Aetna has established a dedicated P.O. Box to accept paper billing rosters for the H1N1vaccinations. Aetna Offers Free CME Courses on Flu Preparedness Physicians who complete the course can earn one category 1 credit toward the AMA Physician’s Recognition Award. All other health care professionals, including office staff, who complete the course will earn a non-physician certificate. Aetna Continues to Reach out to Members to Encourage Vaccination In addition, Aetna is taking the extra step of proactively identifying members who may fall into the categories of “priority individuals” defined by the Centers for Disease Control and Prevention (CDC). “Aetna is using the CareEngine® to identify and reach out to members who fall into several of the CDC’s H1N1 vaccine “priority” categories, including those who are younger than 65 years of age with chronic disease, persons 6 months to 24 years of age, and women who are pregnant,” Fried explained. “Because members in these groups are at higher risk of complications from the H1N1 virus, Care Considerations will be posted to their secure and confidential Personal Health Record with information on H1N1 flu, their specific risk factors, and the suggestion that they speak with their physician about the vaccine.” Personal Health Records compile an individual’s health information gathered from across the health care spectrum, including physician offices, laboratories, diagnostic treatments and pharmacies. Aetna’s CareEngine automatically checks this information against clinical guidelines searching for patient safety issues or potential gaps in care. If the CareEngine finds an opportunity to improve care, the member will receive a Care Consideration alerting them to About Aetna
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