APMA advocacy staff met with an Aetna medical director last week to discuss ongoing member concerns and the recent AHIP press release signed by Aetna and other major health insurers to simplify the prior authorization process. APMA meets with Aetna quarterly to facilitate these conversations and advocate on behalf of our members.
Pledge to Simplify Prior Authorization
Aetna, along with 50 other major health insurance plans, pledged last week to simplify the prior authorization process. They are primarily focused on creating a standardized administrative process for providers, streamlining the process into a uniform one. The end goal at this stage is to have nearly identical forms, submission processes, and clarity of information provided in responses back to providers. Provider specialties are already being engaged about how they interact with the existing systems, and podiatric physicians will be included. APMA looks forward to working with Aetna on this important issue for our members; we are hopeful that a less burdensome and more transparent process will result.
25 and 59 Modifier Denials
APMA has heard a recent uptick from members related to 59 and 25 modifier denial claims. Aetna confirmed that while an edit was implemented in February this year, it has since rolled back that edit and does not anticipate any additional changes. Any members who believe that their claims have been inappropriately denied should appeal these claims. APMA has tool kits on both of these modifiers:
Please contact the APMA Advocacy team with any questions or concerns.