Aetna Announces Coverage for H1N1 Vaccinations
Aetna will cover administration of the H1N1 vaccine for all health plan members
HARTFORD, Conn., September 28, 2009 — Aetna (NYSE: AET) announced today that it will provide first-dollar coverage for the administration of the H1N1 flu vaccine for all of its fully-insured health plan members, and for all members of self-funded plans unless directed otherwise by the plan sponsor. Aetna is offering this coverage even in instances where members’ plans do not include coverage for preventive care or have limits on such coverage. Co-pays, co-insurance and deductibles will not apply for the administration of the vaccine.
“Aetna has responded to Health and Human Services Secretary Sebelius’ call for health plans to do their part to ensure a smooth and effective national emergency vaccination program,” said William Fried, M.D., the Aetna medical director heading the company’s pandemic flu response initiative. “We’ve worked with plan sponsors to liberalize coverage policies, and remove cost or administrative obstacles that could hinder or delay members’ access to the vaccine.”
In a special effort to educate high risk members about the importance of vaccination, Aetna is providing H1N1 training to nurse case managers who work with members enrolled in Aetna’s disease management, case management, and Beginning Right® maternity programs. By definition, members in these programs fall into several of the categories of individuals the CDC has identified for prioritization when the H1N1 vaccine first becomes available. Aetna’s nurse case managers are discussing H1N1 during their ongoing conversations with these members.
Aetna’s comprehensive H1N1 influenza education program has been in place since April 2009 to provide members, customers, and Aetna's own employees with information on the H1N1 flu and tips for preventing infection. Resources available on Aetna's public website www.aetna.com include fact sheets and Q&As, as well as posters and flyers businesses can download and share with employees. Aetna’s website has a video on proper hand washing technique, worksite hygiene, and social distancing techniques. The materials use plain language techniques to make them easy to understand. Educational mailings, including Aetna’s Member Essentials eNewsletter are being sent to members, and H1N1 information is included on Aetna Navigator, Aetna’s password-protected website where health information is customized for members.
Aetna is also reaching out to physicians, hospitals and health care professionals in its network of providers to inform them of Aetna’s reimbursement policies for the administration of the H1N1 vaccine and to offer assistance with preparations in medical offices and health care facilities. “We’ve encouraged providers to complete state registration requirements to become vaccinators, and to review their phone triage procedures and after-hours availability in light of the expected increased demand for medical services,” Fried added. The federal government will pay for the H1N1 vaccines and the supplies needed to administer them. Aetna will reimburse providers for administration of one or two doses of the H1N1 vaccine, based on CDC recommendations.
Aetna’s own H1N1 pandemic influenza planning includes an important business continuity component. The company has plans in place to transfer work within its many sites without disruption should that become necessary. Aetna has also taken steps to prevent infection in its workforce. Posters on preventing the spread of infection are displayed in Aetna’s offices. Aetna provided all office-based employees with antiseptic hand gel to use at work.
Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 36.8 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.
Aetna Supports Physicians, Pharmacists, Members in H1N1 Flu Response
Aetna offers electronic roster billing for pharmacies and non-traditional providers; Aetna offers free CME course for physicians on flu preparedness; Aetna reaching out to high risk members to encourage vaccination
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.
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.
Aetna Offers Free CME Courses on Flu Preparedness
Aetna is offering physicians a free CME course that provides information and resources to help 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,” 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
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.
Founded in 1999, ZirMed is a nationally recognized leader in delivering revenue cycle management solutions to healthcare providers. ZirMed enables healthcare providers to leverage the power of technology to cure administrative burdens and increase cash flow. ZirMed solutions include eligibility verification, credit/debit card processing, check processing, claims management, coding compliancy and reimbursement management, electronic remittance advice, patient statements, patient e-commerce solutions, provider credentialing, and lock box services. ZirMed solutions are designed to complement provider workflow and to provide innovative, creative and flexible solutions for healthcare’s most pressing administrative challenges. For more information about ZirMed, visit www.zirmed.com/pr.
Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 36.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.