1. Aetna’s Clinical Policy Bulletin for Evidence-Based Medical Necessity Determination

As a health insurance company, Aetna is always looking for ways to optimize healthcare coverage and improve the member experience. In order to do this, they have created a Clinical Policy Bulletin for Evidence-Based Medical Necessity Determination. This bulletin provides guidance to physicians and other healthcare providers on how to make decisions about what medical treatments are necessary for their patients.

The Aetna clinical policy bulletin for Evidence-Based Medical Necessity Determination is based on the latest scientific evidence and clinical best practices. It is designed to help physicians and other healthcare providers make more informed decisions about what medical treatments are necessary for their patients. The bulletin provides guidance on how to:

1. Identify the evidence-based recommendation for a particular medical treatment.

2. Evaluate the patient’s individual clinical circumstances.

3. Determine whether the patient’s clinical circumstances meet the criteria for coverage of the recommended treatment.

The Clinical Policy Bulletin for Evidence-Based Medical Necessity Determination is available on Aetna’s website.

2. What is Aetna’s Clinical Policy Bulletin?

Aetna clinical policy bulletin (CPBs) provide guidance to our clinical staff and health care professionals when reviewing coverage requests. Our CPBs are based on a review of currently available medical literature, nationally recognized clinical guidelines and/or peer-reviewed studies.

When making decisions about coverage, Aetna considers the following:

The medical necessity of a service or procedure

Whether the service or procedure is investigational, experimental or unproven

The safety and effectiveness of a service or procedure

Whether the service or procedure is appropriate for the member’s condition

Aetna’s CPBs are developed by our Medical Policy staff, which includes board-certified physicians and other clinical staff members. Our CPBs are reviewed and updated on a regular basis.

Aetna’s CPBs are not intended to replace a physician’s clinical judgment about whether a particular service or procedure is medically necessary for a particular patient. Rather, they are intended to assist physicians in making those decisions.

Aetna’s CPBs are not available to the general public. However, they may be obtained by Aetna members and health care professionals upon request.

3. How can the Clinical Policy Bulletin help improve healthcare coverage?

Aetna’s Clinical Policy Bulletin (CPB) is a reference tool that helps our clinicians and other health care professionals make more informed decisions about coverage for their patients. The CPB includes:

• Aetna’s policies and guidelines for coverage of specific services and treatments

• An overview of the clinical evidence supporting our policies

• A summary of the peer-reviewed literature on the safety and effectiveness of specific services and treatments

• Links to other resources, such as clinical practice guidelines from leading medical organizations

The CPB is updated on a regular basis, as new evidence emerges. We encourage clinicians to check the CPB when they have questions about coverage for a specific service or treatment.

The CPB can help improve healthcare coverage in several ways:

1. By providing a centralized source of information on Aetna’s coverage policies and clinical evidence supporting those policies, the CPB can help clinicians make more informed decisions about which services and treatments to provide to their patients.

2. By regularly updating the CPB with new evidence, Aetna can help ensure that our policies are based on the most up-to-date scientific evidence.

3. By providing links to other resources, such as clinical practice guidelines from leading medical organizations, the CPB can help clinicians find additional information to help them make coverage decisions.

4. What are some of the key points of the Clinical Policy Bulletin?

Aetna’s Clinical Policy Bulletin for Evidence-Based Coverage provides guidance on how to optimize healthcare coverage. The Bulletin includes four key points:

1. Aetna plans should consider evidence-based therapies when making coverage decisions.

2. Aetna will use a systematic review process to evaluate the evidence for new and emerging therapies.

3. Aetna will work with providers to ensure that patients have access to evidence-based therapies.

4. Aetna will continue to monitor the evidence for new and emerging therapies.

5. How can the Clinical Policy Bulletin help optimize healthcare coverage?

Aetna’s Clinical Policy Bulletin (CPB) is a resource that can help you optimize your healthcare coverage. The CPB provides information on a variety of topics, including:

• How to get the most out of your coverage

• What to do if you have a problem with your coverage

• How to choose the right doctor or hospital

• What to expect when you see a doctor

• How to get the most out of your prescription drug coverage

• How to stay healthy and avoid serious health problems

The CPB can help you make the most of your Aetna coverage by providing you with the latest information on a variety of topics. Check back often, as new topics are added regularly.