Aetna CPT Code Pre-Authorization Process Recommendation
Some Aetna insurance plans have implemented a pre-authorization process based both on units and specific CPT® codes. We created the following workflow recommendations to help WebPT Members affected by these new requirements. If your practice is affected, we also recommend reviewing Aetna’s Precertification Lists page to see which CPT® codes require pre-authorization.
Please note that while WebPT will provide your clinic with suggestions on how to best track required authorizations, it is ultimately your responsibility to identify and meet the requirements denoted in your payer agreements.
For Members using WebPT EMR for documentation and RevFlow for billing, we recommend the following:
- The individual responsible for authorizations should access each affected patient's Billing Register in RevFlow, which shows what was included on submitted claims after scrubbing.
- To ensure the claim generation cycle is complete, wait at least one business day after the patient's visit note is finalized.
- Click here to access a spreadsheet you can use to compare what was submitted on the claim against what was authorized.
- The spreadsheet is pre-loaded with an example for illustrative purposes only.
- Formulas are embedded in the spreadsheet for auto-deduction of units.
- Additional rows can be inserted as needed.
- Given the likelihood of multiple authorizations within the same case, we recommend using one spreadsheet per patient.
- Once the patient’s episode of care is complete, we recommend uploading the spreadsheet into either the eDoc section of the patient chart (in the WebPT EMR) or the scanned documents section of RevFlow.
- As claims are submitted, therapists can receive the remaining authorization information via updating the fields identified above or via a manual process of the therapist’s choosing.
- This is a forecasting approach only, as we don't have real-time claim adjudication to reconcile against.
- Enforcement of timely note completion and finalization is essential to having any information to track from the billing register.
- Information will not be in the billing register if:
- Members choose to hold claims on claim delay;
- Claims are going on claim delay for one of our automated reasons; or
- Members hold on the charge audit screen for a set number of days.