Everyone should have a fair and just opportunity to be as healthy as they can be. Learn more about health equity and the obstacles and solutions to this goal on our health equity page. 

Cultural competency flyer (PDF)

Trauma-informed care responds to the impact of trauma through recognition and understanding. We take our members’ safety and ability to make their own choices seriously.

More about trauma-informed care

You can find more information about training on the HEDIS page.

Aetna Better Health Kids Provider Webinar

Wednesday October 16, 2024, 11 am EST

Topics we’ll cover:

This month's Aetna Better Health Kids Hot Topic webinar features a discussion on the Disclosure of Ownership & Controlling Interest Worksheet (DOO Form) and other important information.

We'll provide some information on the following topics:

• What is the purpose of the DOO Form?
• How do you completion the DOO Form?
• What are the Access and Availability Guidelines? 
• How can you use the Availity Portal to support the day-to-day needs of your office?

 Don't miss this important webinar!

Register today! Hope to see you there!

Upcoming webinar dates and tentative topics:

All webinars are held from 11am-12pm EST

• June 26, 2024 — Behavioral Health
• August 21, 2024 — Credentialing
• October 16, 2024 — Hot Topic Webinar & Other Essential Information (PDF)
• December 18, 2024 — Topic To Be Determined

Check back closer to the registration date to RSVP.

Past webinar presentations

• June 2024 : Behavioral Health Webinar (PDF)
• December 2023: Provider Appeals and Disputes (PDF)
• September 2023: Quality Management, Benefits Update (PDF)
• June 2023: MANNA, Pharmacy and Benefits Update (PDF)
• March 2023: Updates and Changes
• August 2022: Medicaid closure and CHIP update
• July 2022: PA Medicaid closure process & CHIP team introductions (PDF)
• June 2022: CHIP expansion and Medicaid closure (PDF)
• May 2022: CHIP expansion and Medicaid closure (PDF)
• April 2022: CHIP expansion and Medicaid closure (PDF)
• March 2022: Provider benefits and CHIP expansion (PDF)
• November/December 2021: Availity tips and cultural competency (PDF)
• October 2021: Provider manual and hot topics (PDF)
• September 2021: Billing requirements, long-term acute care (LTAC) and vendors (PDF)
• August 2021: Prior authorizations (PDF)
• July 2021: Special Needs Unit (PDF)
• June 2021: Metropolitan Area Neighborhood Nutrition Alliance (MANNA) (PDF)
• May 2021: Provider appeals and disputes (PDF)
• April 2021: Availity (PDF)
• March 2021: Claims and billing tips for successful outcomes (PDF)
• February 2021: Credentialing (PDF)

2023 dates coming soon.
 

Questions about EVV before or after the webinar? Just email us and add “EVV question” in the subject line.

• Bright Futures guide (PDF)
• Bright Futures codes and assessments (PDF)
• Bright Futures periodicity schedule and coding matrix (PDF)
• Validated screening tools for developmental delays and autism spectrum disorder (PDF)

You can find more information on our pharmacy benefits page.
 

• Statewide preferred drug list (PDL) FAQs for providers (PDF)
• Asthma medication formulary updates (PDF)

• Billing and claims quick reference guide (PDF)
• Electronic funds transfer (EFT) (PDF)
• Electronic Remittance Advice (ERA) (PDF)
• Office Ally™ clearinghouse (PDF)
• Provider timely submission guide (PDF)

FAQs about provider PROMISe ID enrollment, revalidation and ordering, referring,

• prescribing (ORP) enrollment processes (PDF)
• Instructions for providers to check on the status of their PROMISe ID enrollment (PDF)
• 837 I/P taxonomy requirement (PDF)
• PROMISe ID enrollment claims processing issue identified (PDF)
• PROMISe ID enrollment to be required at all service locations (PDF)
• Required enrollment of ordering, referring and prescribing providers (CHIP) (PDF)
• Required enrollment of ordering, referring and prescribing providers (Medicaid) (PDF)

You can find more information on our complaints, grievances and appeals page.

• Changes to complaints, grievances and appeals process (PDF)
• Provider appeal form (PDF)

• Provider Portal
• Provider forms
• Provider notices and newsletters
• Special Needs Unit
• Pennsylvania Medicaid closure process guide (PDF)
• Telephonic Psychiatric Consultation Service Program (TiPS)
   

2021 provider pay for quality (P4Q) tip sheet (PDF)
 

• International Accreditors for Continuing Education and Training (IACET)
• Accreditation Council for Continuing Medical Education (ACCME)
• Case Management Society of America (CMSA)
• Substance Abuse and Mental Health Services Administration (SAMHSA)
• American Society of Addiction Medicine (ASAM)
• Suicide Prevention Resources Center
• Agency for Healthcare Research and Quality (AHRQ)
• Think Cultural Health

Communication between health care professionals can lead to better outcomes for patients. Not sure where to start? You can check out these FAQs about how to discuss sensitive topics.

• When and how can you share info about patients you’re treating for mental health conditions?
• What are some ways to address social determinants of health challenges?
• Where can you learn more about the HIPAA privacy rule?