Private Payers

Private insurance companies and their differing policies, procedures, and payments add complexity to medical practice today. These resources are intended to assist practices in dealing with private payers.

Aetna

Mental Health

Telehealth

  • Telehealth Services - Learn about Aetna’s virtual care services and member benefits. 
  • Teladoc - The Aetna health plans give access to virtual care through Teladoc.

Prior Authorization

Value-Based Programs/Alternative Payment Models

Medicare Advantage

Recent News

  • Aetna Newsletter - Past and present Aetna newsletters and important reminders. 

Elevance Health (formerly known as Anthem)

Behavioral and Mental Health

Telehealth

  • Anthem Telehealth - Learn about Anthem’s virtual care services and how to use the Anthem Sydney app.

Prior Authorization

Value-Based Programs/Alternative Payment Models

  • Reimbursement Policies - Search for your state to review Anthem’s reimbursement policies and the basis for reimbursement if the service is covered by Anthem.
  • Electronic Data Interchange - Anthem has a strategic relationship with Availity to serve their Electronic Data Interchange (EDI). Register here to exchange claims electronic transactions with Anthem.
  • Enhanced Personal Care - Search for your state to learn more about Anthem’s value-based care program.

Medicare Advantage

  • Medicare Advantage Plans - Information on understanding the MA program, virtual care, and using MA encounter data. 
  • Medicare Advantage Providers - Information for providers with access to information about our plans and member benefits, news and updates, training materials and guides.

Recent News/Other

  • Provider News - Search for your state and stay current on Anthem policies and processes, updated clinical guidelines and other issues impacting your practice and patients. 
  • Forms & Guides - Search for your state and use these tools needed to deliver quality care and support patients and staff. 

Blue Cross Blue Shield

  • Behavioral Health - Learn about the new behavioral health network effective January 1, 2023. 
  • FAQs - Provider information on vaccine and boosters, testing, treatment, telemedicine, and more. 
  • Medicare Advantage - Information on MA costs, limits and considerations, and enrollment. 
  • Provider Hub - Updates on care and coverage related to COVID-19.

Cigna

Behavioral and Mental Health

  • Mind-Body Connection - Information and tools to help you and your patients stay emotionally resilient and foster well-being. Includes behavioral health resources for patients, reimbursement for preventive care services and screenings, screening tools, and more. 
  • Behavioral Health Resources - Includes clinical practice tools, behavioral administrative guidelines, and more treatment guidelines. 

Telehealth

  • Cigna’s Virtual Care (Telehealth) Services - Learn about Cigna’s virtual care options including preventive, urgent, and behavioral/mental health care. 
  • Virtual Care - Read Cigna’s virtual care reimbursement policy to ensure you can continue receiving ongoing reimbursement for virtual care. 

Prior Authorization

  • Precertification Guidelines - Guidelines on when and where to submit precertification requests to Cigna and Cigna’s national ancillary vendors. This includes service specific precertification process guidelines- medical procedure, medications, and behavioral. 
  • Clinical Reimbursement Policies and Payment Policies - Find the most recent Medical Necessity Review list, precertification policies, and modifiers and reimbursement policies. 
  • Master Precertification List - Complete list of services that require precertification of coverage. 

Value-Based Programs/Alternative Payment Models

Medicare Advantage

Recent News

Humana

Behavioral and Mental Health

Telehealth

  • Telehealth and virtual care resources - Technology requirements, eligibility and patient consent, patient marketing resources, comprehensive telehealth playbook, and FAQs.
  • Telehealth FAQs - Visit this page for all your telehealth billing questions and answers. 

Prior Authorization

  • Preauthorization and notification lists - Includes prior, current, and future lists of services and medications for which preauthorization may be required and summaries of changes. Also includes information on submitting requests and state-specific forms.

Value-Based Programs/Alternative Payment Models

  • Value-based care report - Details prevention, outcomes and utilization, and costs and payments for Humana individual Medicare Advantage (MA) members in 2021.
  • Episode-based Models - For episodes of care related to total joint replacement (hip and/or knee), maternity, spinal fusion (lumbar and/or cervical) and coronary artery bypass grafting.

Medicare Advantage

  • Medicare Advantage Materials - Information about the types of MA plans Humana offers. Here you will find reimbursement guidelines, details about provider qualifications and requirements, FAQs, and other information.

United Health

Behavioral and Mental Health

Telehealth

  • Virtual Visits Guide - Information for members on benefits and coverage for telehealth services.
  • Telehealth/Virtual Health Policy - This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form or its electronic equivalent or its successor form. 

Prior Authorization

Value-Based Programs/Alternative Payment Models

Medicare Advantage

*Please note that these policies may differ based on your contract with each payer. In addition, some coverage plans may vary for large, self-insured employers.  

Additional Private Payer Information