Autorización previa
We require prior authorization for select acute outpatient services and planned hospital admissions. Prior authorization is not required for emergency services.
Si el miembro tiene cobertura, y los servicios y aquellos que requieran autorización previa cambian, recibirá un aviso al menos 60 días antes a través del boletín para proveedores, un correo electrónico, actualizaciones en este sitio web, una carta (correo postal de los Estados Unidos), una llamada telefónica o visita al consultorio.
Participating providers can now check for codes that require prior authorization via our Online Prior Authorization Search Tool. If you are a non-participating provider, 100% of all services require a Prior Authorization.
Availity
Helps you spend less time on administration. This way, you can focus more on patient care. You get a one-stop portal to quickly perform key functions you do every day. You can submit submit authorizations or check the status of a previously submitted prior authorization and check patient eligibility and benefits.
To find out what services require authorization or check on the status of an authorization on Availity, please visit our website for more details. For more information about prior authorization, please review the Provider Manual.
Excepciones:
• Las especialidades de emergencia, radiología, anestesiología y patología (ERAP) no requieren autorización cuando se facturan con POS 21, POS 22, POS 23 o el código de rentas 0450 para todos los proveedores.
• Los servicios en la sala de emergencias facturados con POS 23 o tipo de factura 131 con el código de rentas 0450 no requieren autorización para todos los proveedores.
Remember, prior authorization is not a guarantee of payment. Unauthorized services will not be reimbursed.
Archivo de servicios con autorización previa
You must be registered for the Provider Web Portal in order to have access. Please click below to either register or log in.
Certain acute outpatient services and planned hospital admissions require prior authorization before the service can be covered for the member.
For more information, please contact a Provider Relations representative at 1‑866‑600-2139 for more information.
When you request prior authorization for a member, we’ll review it and get back to you according to the following timeframes:
- Rutina: 10 días calendario una vez recibida la solicitud.
- Urgente: tres días hábiles desde la recepción de la solicitud. Una solicitud urgente es apropiada para una afección que no pone en riesgo la vida y que si no se trata de inmediato, dará como resultado una afección peor o más complicada en el paciente. Le sugerimos que llame al departamento de Autorizaciones Previas al 1‑866‑600-2139 para realizar todas las solicitudes urgentes.
Subcontratistas
Aetna Medicare FIDE (HMO D-SNP) works with certain subcontractors to coordinate services that are provided by entities other than the health plan, such as transportation, vision or dental services. If you have a member who needs one or more of these services, please contact Member Services at 1‑866‑600-2139 for more information.
Archivo de servicios con autorización previa
Instrucciones para acceder a las Guías de criterios complementarios de Aetna (PDF)
Boletín de políticas clínicas de Aetna
Medicare Part B Drug Requirements/Guidelines
* agregado el 1/21/2022
Effective October 1, 2025, EviCore, our vendor servicing prior authorizations for Radiology, Cardiology and Pain Management, is moving from their current Isaac platform to their new Image ONE platform. Members that require prior authorizations will be required to submit requests via the CareCore National portal.
Services performed without authorization may be denied for payment, and you may not seek reimbursement from members.