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 H1N1 vaccinations. 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. http://www.aetna.com/pharmacy-insurance/healthcare-professional/H1N1_billing.html
Aetna Offers Free CME Courses on Flu Preparedness
Aetna is offering physicians a free CME course that provides information and resources to help them 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,”1 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.
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