Learn about Aetna Smart Compare. The dental discounts are available through participating healthcare providers only. Orthodontists: correct the position of misaligned teeth and jaws, typically this is done with braces although treatments using other dental devices (such as retainers) are also utilized. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Please check before scheduling an appointment to make sure the provider is participating in the program. Our find a dentist tool includes a brief survey to help us improve this service. Links to various non-Aetna sites are provided for your convenience only. All Rights Reserved. Find your plan listed below and click Find a Dentist. Click here to find an in-network vision provider thats close to you. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. You can further filter the search results by adding a specific dentist . Members should always contact the provider's office in advance to confirm availability. Each main plan type has more than one subtype. Members should discuss any matters related to their coverage or condition with their treating provider. Access2Care performs transportation management services on behalf of Aetna Better Health. Street Address: . Dr. Shannitta Bridgers is a pediatric dentist at Highland Pediatric Dental in Fayetteville, SC. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Working with providers, our advanced care management techniques help increase quality, improve efficiency . Note not all Aetna dental plans and offers available in all markets. SELECT A DIRECTORY. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Please log in to your secure account to get what you need. Aetna Inc. and itsaffiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. The five character codes included in the Aetna Medicaid PA Requirement Search Tool are obtained from Current Procedural Terminology (CPT), by the American Medical Association (AMA).CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Due to the impact of the COVID-19 pandemic, many provider offices may need to adjust their office hours or redirect patients to others offices. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Links to various non-Aetna sites are provided for your convenience only. Used with express permission. Besides treating dental conditions, she educates her young patients on the importance of proper dental health and dispenses practical advice on maintaining dental hygiene. information regarding PA submission or service partner requirements. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Enter Location Log in to find doctors, dentists, hospitals and other providers that accept your plan. 2. To check that your provider participates, visit our website or call us. This search will use the five-tier subtype. All Rights Reserved. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 1367 Walter Reed Rd, 103, Fayetteville, NC 28304. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. You can further filter the search results by adding a specific dentists name and/or the type of dental specialist you wish to see. Please enable it to continue. Visit the secure website, available through www.aetna.com, for more information. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Please contact Eviti Connect at. The member's benefit plan determines coverage. Unlisted, unspecified and nonspecific codes should be avoided. Aetna dental plans are not considered to be qualified health plans under the Affordable Care Act. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. In case of a conflict between your plan documents and this information, the plan documents will govern. You can also get the materials you need in a different language or format. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Pediatric Dentists: provide dental care for children and young adults. Visit the secure website, available through www.aetna.com, for more information. If your patient has primary Medicare coverage outside of Aetna Better Health Premier Plan, please call the Medicare plan for benefits and authorization requirements. Hospitals, long-term care facilities and skilled nursing facilities for rehabilitation, mental health facilities, Federally Qualified Health Centers and Rural Health Centers. There is no obligation to enroll. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. You are now being directed to CVS Caremark site. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Aetna Inc. and itsitsaffiliated companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Links to various Aetna Better Health and non-Aetna Better Health sites are provided for your convenience. Pharmacy, dental or vision providers? Important information for Provider Search users who live in California , Colorado , Connecticut , Delaware , Florida . Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 2/22). If you have any questions about authorization requirements or need help with the search tool, contact Aetna Better Health Provider Relations at 1-855-364-0974. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. Aetna Better Health. All DSNP plans are required to have an approved Model of Care. Click here to request an office transfer. You are now being directed to the CVS Health site. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. logo Aethna Better Health of West Virginia. New and revised codes are added to the CPBs as they are updated. Find your plan listed below and click Find a Dentist. Please log in to your secure account to get what you need. *Required Selections. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Select a Plan * Select a Plan: 2. Dental Savings Plans reduce the cost of dental care by 10%-60%, at thousands of participating dentists and dental specialists nationwide. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Applicable FARS/DFARS apply. Copyright 2015 by the American Society of Addiction Medicine. CPT is a registered trademark of the American Medical Association. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Some subtypes have five tiers of coverage. VisitPharmacy Provider Search to view all your pharmacy providers. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). This Agreement will terminate upon notice if you violate its terms. For enhanced adults benefit, visitDental Provider Searchto view your dental providers. Avsis provides vision and dental claim and administrative services by agreement with Aetna Inc. Each plan has its own provider network. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Of course you can use our directories to find doctors and hospitals that take your insurance. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Since there is no paperwork or reimbursement, you must pay for the service at the time its provided. Address, phone number, and practice changes. Enter Location Details Zip Code: OR. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. To search for a dentist, please choose a state, your plan and enter the zip code under the Enter Your Geographic Area section. The HMO plan is ideal for employers in urban locations who want to offer simple, convenient care with fixed, predictable costs. Aetnamedicare.blob.core.windows.net. Or they can help you find a provider. Youd likely go to an oral surgeon if you have an impacted wisdom tooth or need another type of other complicated extraction. Links to various non-Aetna sites are provided for your convenience only. Visit our Medicare page for more DSNP resources, including cost-share information. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). You are now being directed to CVS Caremark site. Exception Detail, Svc Partner Detail - When the. When making an appointment, please be sure your provider offers all services you may need, Avsis Incorporated and Avsis Third Party Administrators, Inc. (Avsis), are wholly owned subsidiaries of Guardian. The path to healthy starts here. Dental Providers: Register now for AetnaDental.com Medical Providers: Register for Aetna's Provider portal on Availity: By clicking on I accept, I acknowledge and accept that: Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". To see if your doctor is in our network, click a plan link below. The member's benefit plan determines coverage. Enter a zip code to search for dental care professionals in your area. The AMA is a third party beneficiary to this Agreement. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Select a Plan * Select a Plan: 2. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Please be sure to add a 1 before your mobile number, ex: 19876543210. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Best viewed in Microsoft Internet Explorer 6 and higher, resolution 1280x800. You can email your search results or print them. Please be sure to add a 1 before your mobile number, ex: 19876543210. This Aetna provider directory includes all Aetna participating providers, including both medical providers and dental providers. You can use the links below to find in-network providers and pharmacies nearyou. You can also get the materials you need in a different language or format. Experience and expertise to help our customers and members navigate the complex global health care landscape. Health. All services deemed "never effective" are excluded from coverage. For more details see our Privacy Policy. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. You can get dental care when you join Aetna Better Health of West Virginia. Unlisted, unspecified and nonspecific codes should be avoided. If you have questions, visit our contact us page. This list is updated nightly. Providers may not balance bill members who do not have cost-share responsibility (including QMB-only). Were a health care company thats building a healthier world. This search will use the five-tier subtype. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. Links to various non-Aetna sites are provided for your convenience only. These directories of Louisianas network providers includes: Enter provider or facility name or select a specialty. Aetna Inc. and itsitsaffiliated companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Aetna Smart Compare is a designation we give to doctors in our network who have proven time and again that they provide high-quality, effective care. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Note not all plans and offers available in all markets. CPT only copyright 2015 American Medical Association. Treating providers are solely responsible for medical advice and treatment of members. Endodontists: help heal infections of the soft tissue inside the tooth and are typically the dental specialist youd see if you need a root canal treatment. 1999- What's covered? . Some plans exclude coverage for services or supplies that Aetna considers medically necessary. To reduce the Plan from an employer Aetna Medicare plan, Individual health plan Aetna Medicaid plan Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Of course you can use our directories to find doctors and hospitals that take your insurance. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. Want to help transform health care? However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Aetna Dental Savings Plans are NOT dental insurance and the dental savings will vary by provider, plan and zip code. Medicaid. Aetna Dentists Near Me. Please refer to your Summary Plan Description (SPD) for an outline of your plan's covered benefits . Filter Type: All Symptom Treatment Nutrition Dental Services Aetna Medicaid New Jersey . Pharmacy prior auth phone number: 1-855-221-5656. Avsis provides vision and dental claim and administrative services by agreement with Aetna Inc. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Go to the American Medical Association Web site. You also can look for more than 25 other types of health care providers, including pharmacies, marriage counselors, urgent care centers, acupuncturists, drug and alcohol counselors, hospice care providers, dialysis centers, vision care providers, flu . Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Please refer to your Evidence of Coverage prior to contacting a Specialist if you are unsure, or call Member Services. It is only a partial, general description of plan or program benefits and does not constitute a contract. Find a Dentist. Some subtypes have five tiers of coverage. Applicable FARS/DFARS apply. Links to various non-Aetna sites are provided for your convenience only. If you do not intend to leave our site, close this message. Click here to find an in-network dental provider thats close to you. If services are not covered by the Medicare plan, Aetna Better Health of Ohio may cover these services. Please log in to your secure account to get what you need. Each main plan type has more than one subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Applicable FARS/DFARS apply. Search result definitions: NOTE: When selecting by CPT group, the results displayed include CPT codes where Provider site; Please america; Search. Enter your location by address, city or zip code. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. Exploration our provider manuals for find resources concerning Aetna policy guidelines that explain how to work with us. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. up to six Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding This information helps us provide information tailored to your Medicare eligibility, which is based on age. Please confirm with the provider when you call them. Prior Authorization may be required. As a LIBERTY enrollee (including enrollees with disabilities), you have full and equal access to covered services as required under the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973. * Enter Provider ID : * Enter NPI : *Provider Type : Select a Provider Type Medical (Includes Behavioral Health) Dental Facilities. You can also get the materials you need in a different language or format. Applicable FARS/DFARS apply. We work with physicians to develop common platforms and goals, shifting the focus from episodes of care to making patient populations healthier. Aetna has one of the nation's largest dental networks, with more than 200,000 participating dental practices, making it easy to find a great dentist or specialist near you. Others have four tiers, three tiers or two tiers. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. Participating Providers: To determine if prior authorization (PA) is required, enter The NJFC Directory of Dentists Treating Children under the Age of 6, Directory of Dentists Treating Members with Intellectual Disabilities Adult, Directory of Dentists Treating Members with Intellectual Disabilities Child, Directory of Dentists Treating NJFC in Long Term Care Facilities. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Periodontists: these dentists specialize in treating complex cases of gum disease, along with other infections or problems involving the tissues that support the teeth. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Links to various non-Aetna sites are provided for your convenience only. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Click here to request an office transfer. CMS requires providers to take the Model of Care training course (PDF). Do you want to continue? Aetna Inc. and its affiliated companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. CPT only Copyright 2022 American Medical Association. . If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). 2023 DentalPlans.com, Inc. All Rights Reserved. Neither Aetna Inc. nor its subsidiaries are Guardian affiliates. 2020 Avsis Incorporated. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. The information you will be accessing is provided by another organization or vendor. LIBERTY makes certain language assistance services available to you at no cost. It provides coverage for a wide range of dental services, including . Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. In-network coverage only (except emergency . No fee schedules, basic unit, relative values or related listings are included in CPT. Dentists and dental office professionals, log in to Aetna Dental to handle claims, find forms, stay ahead of policy changes and more. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. To get started: 1. New and revised codes are added to the CPBs as they are updated. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Members should show their DSNPmember ID cardand their state-issued Medicaid card. Your plan may only provide benefits if you obtain a referral from your General Dentist prior to receiving treatment from a Specialist. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. Disclaimer of Warranties and Liabilities. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610.