Provider participation may change without notice. Providers are independent contractors and are not agents of Banner l Aetna. This material is for information only and is not an offer or invitation to contract. 98point6 is a registered trademark of 98point6 inc. 98point6 is not available in all Banner|Aetna plans offered through employers. Aetna and CVS Pharmacy® are part of the CVS Health family of companies. Aetna and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are both within the CVS Health family.Īccess to the 98point6 application is included in all Banner|Aetna ACA individual & family plans. Aetna and Banner Health provide certain management services to Banner|Aetna. Each insurer has sole financial responsibility for its own products. Banner|Aetna is an affiliate of Banner Health and of Aetna Life Insurance Company and its affiliates (Aetna). Health benefits and health insurance plans are offered, underwritten, and/or administered by Banner Health and Aetna Health Insurance Company and/or Banner Health and Aetna Health Plan Inc.
Our law department makes the final determination if there is any question regarding the applicability of any particular law.
If our policy varies from the applicable laws or regulations of an individual state, the requirements of the state regulation supersede our policy when they apply to the member’s plan. The member appeal process applies to appeals related to pre-service or concurrent medical necessity decisions.Īpplication of state laws and regulations For these issues, the practitioner and organizational provider appeal process only applies to appeals received subsequent to the services being rendered. These issues relate to decisions made during the precertification, concurrent or retrospective review processes for services that require precertification. For example, issues related to the provider contract, our claims payment policies, or processing errors. These issues relate to all decisions made during the claims adjudication process. This quick reference guide shows you when and where to submit disputes Issue types
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