Aetna Participating Provider Agreement

In concluding the participating supplier agreement, the supplier undertakes to comply with all listed terms and conditions, to comply with all Aetna Better health guidelines, procedures and programs in force, as well as the Aetna Better Health Provider manual. In addition, the supplier agrees with Aetna Better Health`s ongoing monitoring of the supplier to ensure compliance with the above. Below is a representative list of policies, procedures and programs that suppliers must comply with. This list is not exhaustive and can be changed after notification to the affected suppliers. Suppliers must meet three different requirements to become participating suppliers with Aetna Better Health: 1) suppliers must enter into an agreement with Aetna Better Health of Kentucky; 2) submit all necessary information; and 3) submit Kentucky MAP-811 (Kentucky Medicaid registration application) or Kentucky Medicaid provider number. Suppliers must approve the terms of the Aetna Better health provider participation agreement, including, but not limited, to obtaining all necessary provisions of the federal state and an acceptable professional image in the community. If the supplier or Aetna Better Health wishes to terminate the participating supplier contract, this must be done in accordance with the contract. Suppliers must maintain their licenses and certifications in good condition and cooperate with the Aetna Better Health Recredentialing program. Aetna Better Health must be informed of any significant changes in the supplier`s qualifications that affect the continued accuracy of the registration information provided to Aetna Better Health.

Participating vendors link with the Kentucky Health Information Exchange (KHIE). Suppliers ensure that vendor-to-supplier records are transmitted in a timely and confidential manner, in accordance with Section 8. Quality management of this vendor guide under „Transfer of Medical Records.“ In Section 4 – Member Services and Benefits of this Provider Manual, suppliers must familiarize themselves with and comply with aetna Better Health „Members Rights and Responsibilities.“ Suppliers are available to Aetna Better Health members under Section 2 – Supplier Management and the supplier`s role in this „Time and Wait Time“ offer guide. Providers agree with other participating Aetna Better health providers to ensure 24-hour call coverage for their members, as outlined in this provider manual. Please note that the National Committee for Quality Assurance (NCQA) requires that access to Medicaid receptors be no less than that of all other patients. Aetna Better Health and its providers are partners in the health care management of Aetna Better Health members. Because of this mutual responsibility, we require Aetna Better health care providers to meet the following standards: Suppliers must protect the privacy of all information that a particular member identifies in accordance with federal and regional laws.