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  • 1.  Aetna Authorization Denials

    Posted 09-16-2022 10:49
    Good morning,

    Is anyone else having on-going issues with Aetna claim denials due to authorization? We are obtaining authorizations via Evicore, yet Aetna continues to deny. We are looking to see if any other groups are having similar problems that we are. 

    Thanks,
    Danielle

    ------------------------------
    Danielle Zine
    Sr. Manager
    Mass General Brigham
    Charlestown MA
    (617) 724-4106
    ------------------------------


  • 2.  RE: Aetna Authorization Denials

    Posted 09-16-2022 10:54

    Yes!

    Either they deny with an authorization or they deny when Evicore tells us no auth required.

    This is a never ending issue and I cannot get anyone to help to rectify it.

     

    Joanne Chichizola

    Billing Manager

    Description: image001Description: <a href=image002.png@01D4F5C8.AEAC51A0">

    777 Passaic Ave, Clifton, NJ 07012

    Phone: (973) 284-0020 X 1304

     Fax: (973) 284-6310

     

     




    Original Message


  • 3.  RE: Aetna Authorization Denials

    Posted 09-16-2022 13:24
    We are getting denials on our PET scans.  We have a copy of the Aetna coding guidelines, and have appealed what Aetna shows payable under the guidelines and still denies as experimental/investigational.    


    Dawn R. Krueckeberg, MBS
    Billing Operations Manager
    P: 2604694766
    F: 2604845919

    FWRadiology
    Breast Diagnostic Center
    PET Imaging Services
    3707 New Vision Drive
    Fort Wayne, IN 46845


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    Original Message


  • 4.  RE: Aetna Authorization Denials

    Posted 09-16-2022 13:48

    Dawn,

    Are they Medicare plans? If so, they may be using Medicare guidelines.

     

     

    Joanne Chichizola

    Billing Manager

    Description: image001Description: <a href=image002.png@01D4F5C8.AEAC51A0">

    777 Passaic Ave, Clifton, NJ 07012

    Phone: (973) 284-0020 X 1304

     Fax: (973) 284-6310

     

     




    Original Message


  • 5.  RE: Aetna Authorization Denials

    Posted 09-16-2022 14:19
    A mixture.   We use the NCD guidelines showing the code is a payable code on the medicare plans.


    Dawn R. Krueckeberg, MBS
    Billing Operations Manager
    P: 2604694766
    F: 2604845919

    FWRadiology
    Breast Diagnostic Center
    PET Imaging Services
    3707 New Vision Drive
    Fort Wayne, IN 46845


    CONFIDENTIALITY NOTICE The information contained in this email may contain legally privileged and confidential information intended only for the use of the individual noted above. If you are not the intended recipient or employee or agent of the entity listed above, you are hereby notified that any reading, disclosure, distribution or copying of this email communication in any way, or the taking of any action in relation to this communication is strictly prohibited. If you have received this email in error, please immediately notify the sender and contact our Security Officer at (260) 469-4751. If you were not the intended recipient, please delete it from your files. Thank you for your compliance.



    Original Message


  • 6.  RE: Aetna Authorization Denials

    Posted 09-16-2022 15:57
    Yes we are, but it is with a particular HMO plan of Aetna.



    Original Message


  • 7.  RE: Aetna Authorization Denials

    Posted 09-19-2022 10:00
    YES!
    No answer from them either.


    Dennis Wiseman
    Chief Executive Officer
    Radiology & Imaging of South Texas
    3226 S. Alameda Street
    Corpus Christi, TX 78404

    Sent from my iPhone

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    Original Message


  • 8.  RE: Aetna Authorization Denials

    Posted 09-20-2022 05:41

    We have had many authorization issues with Aetna. The main one being that we are hospital-based radiologist. The hospital is responsible for getting the authorization and we are covered under their auth. However, if the procedure is done while the patient is in observation status the inpatient auth does not cover the procedure. The hospitals don't get auth's for observation because it is not required, they do not realize or are not told that the imaging done during the observation stay do require auth's even if the stay does not.  We have to end up writing these off.

     

    There was also a separate issue where the auth numbers where not transferring from the Evicore auth number to the Aetna auth number. Our Aetna rep had to do a claims project to find these particular ones and have them reprocessed.



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    Kimberley Cantrell
    Compliance Auditor
    Summit Radiology Services
    Cartersville GA
    (770) 607-7339
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    Original Message


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