Aetna Supports Physicians, Pharmacists, Members in H1N1 Flu Response
By: Health Insurance
Submitted: 2009-11-10 18:54:25 | Word Count: 879
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
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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 H1N1 vaccinations. Additional information
on how providers can bill Aetna for administration of the H1N1 vaccine is
available on the fact sheet posted on the healthcare professionals section of
Aetna`s website.
http://www.aetna.com/pharmacy-insurance/healthcare-professional/H1N1_billing.html
Aetna Offers Free CME Courses on Flu Preparedness
Aetna is offering physicians a free CME course that provides information and
resources to help them prepare for the pandemic flu or similar health crisis.
The CME for physicians entitled "Pandemic Flu: Aware and Prepared CME" is a
one-hour course. The course is available online at AetnaEducation.com, Aetna`s
education site designed specifically for health care professionals.
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
Aetna continues to expand its educational resources for health plan members.
Updated information on its public website includes a new H1N1 Self Evaluation
tool made available by the U.S. Department of Health and Human Services and
developed in collaboration with Emory University School of
Medicine.http://www.flu.gov/evaluation/ This tool helps members understand their
flu symptoms so they can make informed decisions about whether they need to see
their doctor or even proceed to the nearest emergency room. Aetna`s DocFind
search tool now includes information on flu shot clinics.
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,"1 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 CareEnginefinds an opportunity to improve
care, the member will receive a Care Consideration alerting them to that
information. The CareEngine and Aetna Personal Health Record are available to
members of most of Aetna`s fully insured plans and many self-funded plans.
