Healthyhappenstogether
ProviderManual
2022/2023
AetnaBetterH/WestVirginia
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884856-WV-EN(1/2023)AetnaBetterHealthofWestVirginia
TableofContents
Chapter1–WelcometoAetnaBetterHealth7
AboutUs7
ModelofCare7
ServiceArea8
AboutThisManual8
Chapter2–Contacts9
Importantphonenumbers9
Importantaddresses9
Websites9
ReportingSuspectedFraudandAbuse10
Chapter3–ProviderServicesDepartment11
ClaimsInquiryandClaimsResearch(CICR)11
ProviderRelations11
JoiningtheNetwork11
Practitioner/ProviderOrientation12
Newsandothercommunications12
Chapter4–Practitioner/ProviderResponsibilitiesandImportantInformation13
StateofWestVirginiaEnrollment13
NationalProviderIdentifier(NPI)Number13
AccessandAvailabilityStandards13
*ManagementofAfter-hoursAccess14
MonitoringofStandards15
ResolutionofDeficiencies15
CoveringPractitioners16
UseofNon-participatingPractitioners/Providers16
TerminationandRestrictions16
AncillaryPersonnelPerformingServices16
VerifyingEnrolleeEligibility17
SecureWebPortal17
OverviewofFeaturesforMembers17
EducatingMembers18
PatientSelf-DeterminationAct18
PrimaryCarePractitioners(PCP)19
SpecialistPractitioners19
SpecialistPractitionersActingasPCP19
Practitioner/MemberandProvider/MemberRelationships19
EmergencyServices19
UrgentCareServices19
LabServices20
GeneticTesting20
Non-CoveredServices20
HomeandCommunityBasedServices(HCBS)20