Availity jacksonville fl careersource

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JAXUSA also attracts and retains top talent, working with regional education partners on collaborations like Earn Up to ensure businesses have the workforce they need when they are expanding and investing in Northeast Florida. The Heart of the City A top priority of the Chamber is to promote investment and business activity in Downtown Jacksonville: n.

In , the group went to Detroit, where the arts community and entrepreneurs are making a move in a long-struggling urban core. Johns River and we should settle for no less. Chamber leaders convened meetings with developers working on major Southbank projects to facilitate conversation and make sure everyone is working together to maximize river access and take advantage of the public investment along the Southbank Riverwalk.

With more than members, ImpactJAX offers a vibrant opportunity to get involved and give back. Comprised of businesses from Mayport Village to Ponte Vedra, the Beaches Division boasts 1, members and serves nearly member businesses. The Beaches Division offers an array of networking opportunities, including after-hours mixers, monthly luncheons and Coffee on the Coast. The Beaches Business Growth Series brings members together to learn new skills and grow their business during small-group, interactive lunch sessions.

With six geographic and four business resource Councils, the Councils total more than 1, members in the community.

Any employee of a Chamber member company is eligible for membership in one or more Councils. Each Council hosts monthly meetings and countless opportunities to connect, network and give back to the community. Building on Chamber Connections Burnell Goldman was on the job less than two months when a Chamber Trustee membership renewal landed on his desk. New people eventually means more business for the restaurant. Goldman was sold. She and her husband were already franchise owners of a local Chick-fil-A with a big national ad budget.

For Christine, it was a civic duty. Since then, Wier has gone on to a successful career in real estate, joining Keller Williams Atlantic Partners in Several past Chamber chairs were on hand to cut the ribbon on our renovated Downtown building at the Annual Meeting. Smith of Kenneth L. To learn more about volunteer opportunities, call The Trustees hold quarterly receptions with top newsmakers and business leaders, among other opportunities for high-level connections.

In July, Mayor Lenny Curry broke the news that Deutsche Bank was investing and expanding in our community, adding hundreds more jobs in Jacksonville.

The Chamber hosts small group gatherings of Trustees designed for making meaningful professional and personal connections. The Chamber launched Trustee Insider, a quarterly newsletter exclusively for Trustees, designed to provide an inside look at targeted issues the Chamber is involved in and the impact it is having on our community.

It also sells packaged pickled products in natural food grocery stores including Native Sun. We have also grown to offer additional services to our clients, which include land development, providing material supplies and management consulting. Onas firmly believes that our time-tested philosophy of being committed to providing the highest quality services to our clients regardless of the size of the project is the key to our success.

You can expect the same outstanding results and accountability from each project Onas undertakes. Onas Corporation is a state certified Minority Business Enterprise.

Waste Pro services the solid waste. Gardner Park, Metropolitan Park and numerous others:. It helps us develop solid relationships with numerous decision makers within the business community; and it has turned many conversations into sales with the participants as well as the other vendors.

JAX Chamber Trade Show Showcase your business at the Trade Show and join more than business professionals for an evening of networking and product sampling.

Exhibitor space and sponsorship opportunities are now available. Patch myjaxchamber. We aim to be good company citizens through charitable works and supporting community involvement. To practice law with honesty and integrity. My goal is to not only provide a superior photo product, but to go beyond this and capture the unique personality and inner passion of the client in a way that translates to the viewer. My business philosophy, which I apply to all business activities and decisions, is based on three principles: always do the right thing, be responsive, and help others.

We move them forward by lifting them out of financial chaos, and improve their profitability and cash flow while maintaining the highest integrity and discretion. ATG uses science and measurement to give companies the facts to prove the quality, efficiency and return on investment of human resource decisions. Our goal is to create safe, life-long swimmers who enjoy and respect the water as much as we do. These are the cornerstones of Edible Arrangements and drive everything we do.

Through the process of helping others to reach their goals, we also reach ours. Our programs prepare leaders for roles that bring positive change to Northeast Florida. Workforce Development Workforce Development connects people with work experiences, provides industry internships for teachers, advocates for more college access points and engages employers in developing lifelong learning opportunities for their workforce.

Alan Mosley Alpine Air, Inc. Carol C. Otwell, Spectrum Signs and Graphics, Inc. The JWBC provides entrepreneurial education, counseling, business connections and targeted mentoring to build a viable entrepreneurial community in Northeast Florida. Ed and Billie Jo Burr Emily Dawkins Enterprise Holdings Foundation Fitzhugh Powell Jr. Powell and Company Gail Bird, Wells Fargo Genie James, www.

Gina Hill Giselle Carson, Marks Gray, P. Heidi Lang Henry Brown Hester Clark Jacksonville University. Jamie and Alison Korman Shelton Jan and John Hirabayashi Janet M. Janet Owen Jeane Sumner, ChasingType Jerry Mallot Jim Cataland JPMorgan Chase Katherine Way, Katherine Way Collections Kathyrn Murphy, Comfort Keepers Mark and Meredith Frisch Mary Fisher, Fisher Design Mark Vandeloo - General Manager.

Kathy Snowden - Market Leader. CBRE Mr. William Gulliford - Executive Managing Director. Fitzhugh Powell - President. Century Ambulance Mr. CGI Ms. Champion Brands Inc. Chang Industrial Mrs. Kate McAfoose - Program Manager. Charles Perry Partners Inc. Chase Properties Mr. Michael Balanky - President. Christine Wier - Realtor. Jamie Brooks - Director of Business Development. Citi Mr. Citi Ms. City Facilities Management Mr. Clear Channel Outdoor Inc. Brent Bolick - President, Jacksonville Division.

Clearwave Fiber Mr. Clockwork Marketing Services Ms. Maxine McBride - President. Coach Inc. Coca-Cola Beverages Florida Mr. Jamaal Medley - Territory General Manager.

Coca-Cola Beverages Florida Mrs. Kristen Harris - Sales Director. ColoCSX Ms. Comcast Mr. Comcast Ms. Kenyon Sutton - Financial Wellness Officer. Complete Weddings and Events Ms. Kathleen Stanley - Co-Owner. Daniel W. Connell Jr. Daniel Connell - Past Chamber Chair. Rick Welch - President. Corner Lot Development Group Mr. Christian Allen - Owner. Covius Holding Inc. Cox Media Group Ms. Joy Bell - Integrated Media Consultant. Jeff Craig - CEO.

Crocker Partners Mr. Cross Regions Group Mr. Doug Smith - Chief Operating Officer. Crown Castle Mr.

Manish Khullar - Commercial Account Executive. Crown Castle Ms. Nancy Chrisman - Strategic Accounts Director. CSI Companies Mr. Thomas Rauch - Technical Sales Director.

CSI Companies Ms. Diana Lanza - Sales Manager. Traci Jenks - Senior Director. Customers Bank Mr. Max Glober - Director of Marketing. DAK Resources Mr. The Dalton Agency Mr. Daniels Law Firm Ms. Millicent Daniels - Attorney.

Danis Construction Ms. Ashley Szczukowski - Director of Business Development. Debbie Buckland - Past Chamber Chair. Deutsche Bank Mr. Kevin Dooley - Head of Human Resources.

DEX imaging Inc. Don Quick - Branch Manager. Downtown Investment Authority Ms. DPR Construction Mr. Jacob Glass - Project Executive. William Rupp -. Patrick Zalupski - President.

Swan - Vice-President. Matthew Breuer - Partner. Steven Diebenow - Partner. Ray Driver - Partner. Drummond Press Mr. John Falconetti - President. DuBlase Whiskey Mr. Duval County Public Schools Dr. Diana Greene - Superintendent. Duval Motor Company Mr. Shawn Ashley - Owner.

Edward Waters University Dr. Anna Stavredes - Account Executive. Earl Kelly - Owner. Elite Home Health Mr. Brandon Groover - President.

Elite Parking Services of America Mr. Dane Grey - President. Stephen Lovett - Partner. Embraer Defense and Security Inc. Norman Ramby - General Manager. Emtec, Inc. Doug Goodall - Managing Director. The Energy Authority Ms.

Tyler Mathews - President. David Sillick - Business Development Manager. Enviro-Cat Ms. Catherine Orr - CEO. Linda Henry - Director of Catering Sales. Michael Middleton - Principal.

Heather Adams - Administrative Director. Fable Heart Media Mr. Nick Leonard - Founder and Creative Director. Anthony Conte - President. Fanatics Mr. Lonnie Phillips - Chief Customer Officer. Farther Mr. Daniel Gilham - Financial Advisor. FaverGray Ms. Paige Rosenberger - Director of Marketing. Federal Reserve Bank Branch Mr. Fidelity Investments Mr. Fidelity National Financial Inc. Fifth Third Bank Ms. Fifth Third Bank Mr. Brian Evans - President, Jacksonville Market.

Fintainium Mr. Richard Jackman - CEO. Brett Nakfoor - Consultant. Julie Graham - Vice President. First Coast News Mr. Jeffrey Whitson - Director of Sales. First Florida Credit Union Mr. First Horizon Bank Mr. FIS Mr. David Rice - Chief Physician Executive.

Florida Blue Mr. Andrew Carroll - Strategic Account Executive. Florida Blue Ms. Florida Combined Life Mr. Florida East Coast Railway Mr. Robert Wood - President. Jim Bush - Director, External Affairs. Florida State College at Jacksonville Dr. John Avendano - President. Florida Theatre Mr. Numa Saisselin - President. Florida Theatre Ms. Michelle Adams - Development Director. The Florida Times-Union Mr. David Sandeen - Senior Account Manager.

Kevin Hyde - Managing Partner. Forcura Mr. Craig Mandeville - CEO. Forking Amazing Restaurants Mr. Matthew Mannick - President. Teri Sowder - Director. Future Home Loans Mr. Ryan Proffitt - Mortgage Broker. GAI Consultants Inc. Gallagher Mr.

Gameday Tailgate Experience Mr. Troy McNair - Partner. Gas South Mr. Jason Dolder - Vice President of Sales. John Peyton - President. Gatlin Development Mr. Frank Gatlin - Principal. Chelle Thomas - Business Development Representative. Gilbane Building Company Mr. Ryan Sitnik - Business Development Manager. Jesus Garay - CEO. Golden Ox Liquors Mr. Shlok Motiwala - Owner.

Traci Irven - Assistant Manager. Goodwill Industries of North Florida Inc. Rachael Mueller - Chief Development Officer. Jason McCarthy - Founder. Graybar Electric Co. Rick VandenBossche - Branch Manager. Liam O'Reilly - Regional President. Gresham Smith Mr. Rick Bouchereau - Managing Principal. Group 4 Design Mrs. Leigh Gunn - Interior Design Principal. GuideWell Source Mr. Harvey Dikter - CEO. Gunster Law Firm Ms. Megan Moon - Associate. Hakimian Holdings, Inc.

Halff Associates, Inc. Brad Ezell - Vice President. Adam Prom - Attorney. Orender - President. Hanania Automotive Group Mr. Hancock Whitney Bank Mr. Randy Chesak - Market President. Haskell Mr. Allan Iosue - Director of Strategic Accounts. High Reason Mr. High Reason Ms. Mark Bonner - Vice President. Hoefer Welker Mr. Trevor Lee - Partner. Hoffmann Coaching Mrs.

Terry Hoffmann - Owner. Joshua Roberts - Attorney. Ellen Wiss - Principal. Hunger Fight Mr. Dean Porter - Development Director. Hyatt Regency Jacksonville Riverfront Mr. Joe Hindsley - General Manager. Hylant Ms. Anne Bean - Market President. Hylant Mrs. IceMen - Jacksonville Mr. Iconic Real Estate Investments Mr. Farley Grainger - President. Indelible Business Solutions Inc Ms. Charles Margiotta - Vice President. Insite Radiology Mrs. Tara Volpe - Marketing Director.

Interior Fusion Mrs. Tracie Harmon - New Business Development. IT Ninjas Mr. Bart Whaley - Owner. Matthew Colley - Sales Manager. Gregory Jones - President. Danielle Wampler - Institutional Development Officer. White Enterprises Ms. Ja-Ru, Inc. Andrew Selevan - President. Dana Doody - Executive Director.

Jacksonville Aviation Authority Mr. Jacksonville Children's Chorus Ms. Jacksonville Children's Chorus Mr. Jacksonville Civic Council Ms. Jacksonville Daily Record Mrs. Angela Campbell - Publisher. Charles Greene - Owner. Chad Johnson - COO. Mark Lamping - President. Jacksonville Jumbo Shrimp Mr. Jacksonville Lean Consortium Mr. Jerry Bussell - President. Jacksonville Magazine Mr. Eric Green - CEO. Rachael Tutwiler Fortune - President.

Tim Rogers - Library Director. Jacksonville Symphony Association Mr. Jacksonville Transportation Authority Mr. Nathaniel Ford - CEO. Jacksonville Transportation Authority Mrs. Jacksonville University Mr. Tim Cost - President. Jacksonville Winlectric Mr. Cody Smith - Inside Sales. Mike Dykes - Vice President.

James C. Rinaman, Jr. James Rinaman - Past Chair. JanSan Mr. Josh Davis - President. Jasper Engines and Transmissions Mr.

Sue Kowalewski -. Andy Zarka - Owner. JEA Ms. Sheila Pressley - Chief Customer Officer. JEA Mr. Jessie Ball duPont Fund Ms. Katie Ensign - Senior Program Officer. Mari Kuraishi - President. Jimerson Birr, P. Charles Jimerson - Managing Partner. Casey Gunnell - Group Vice President. Kara Leonard - Head of Human Resources. JP Morgan Chase Mr. Alexander Sifakis - President.

K9s for Warriors Mr. Donnie Horner - Major Gifts Officer. Erik Kasper - President. Keiser University Ms. Lisamarie Winslow - Campus President. Keith E. Johnson CPA, P. Keith Johnson - Principal. Ken McCray Photography Mr. Ken McCray - Owner. Kennetic Productions Inc. Kessler Creative Ms. Fatima Gulamali - Sales Executive. Kimley-Horn and Associates Inc. Brad Tompa - Client Development Manager.

Archie Bouie - Chief Operating Officer. Chelsea Carroll - Managing Director, Audit. Lamp Sales Unlimited Inc. Sean Valliere - Vice President. Landstar System Inc. Leadership Jacksonville Inc. Gracie Simendinger - Chief Executive Officer. Thomas Lee - Vice President. Leerie T. Jenkins, Jr. Leerie Jenkins - Past Chamber Chair. Jessica Brant - CEO. Lonnie Marts - CEO.

Liberty Landscape Supply Mr. Mike Zaffaroni - Owner. Derek Neal - CEO. Angie Byrd -. Lifework Leadership First Coast Mrs.

Tammie McClafferty - Executive Director. Lift Power Inc. Joe Deegan - Sales Manager. Soo Gilvarry - CEO. Ward Huntley - Chief Executive Officer. Phillip Parsons - Property Manager. Olivia Frick - Business Development. Wilford C. Lyon Jr. Wilford Lyon - Past Chamber Chair.

Michael Atack - Senior Manager. Jaclyn Normandin Barnette - Director of Development. Manifest Distilling Mr.

Jim Webb - General Manager. Marand Builders Inc. Nathan Hayes - Senior Vice President. Nate Dickinson - Director of Preconstruction. Marks Gray, P. Crystal Broughan - Shareholder. Martin Coffee Co. Ben Johnson - President. William C. William Mason - Past Chamber Chair. Matthews Design Group, Inc. Rob Matthews - President. Mayo Clinic Dr. Kent Thielen - CEO.

McGlinchey Stafford Ms. Adina Pollan - Attorney. McGowan Medical Centers Dr. Shelita McGowan - Chiropractor. Mark McCrary - President. Medtronic Inc. Mere Mrs. Kate Spilsbury - Owner. Patrick Franklin - Vice President. Todd Stevens - Vice President. Meyer Najem Construction Mr. Michael Baker International Mr. Gregory Kern - Chief Operational Officer. Millennium Physician Group Ms.

Miller Electric Company Mr. Ronald Autrey - Chairman of the Board. Brent Zimmerman - General Counsel. Edward Witt - Senior Vice President. Scott Morrison - Director, Business Development. Modern Aesthetic Centers Mr. Paul Hassan - CEO. Momni Boutique Mrs. Joy Lee - President. Money Pages Mr. The Monique Burr Foundation Ms. Morales Construction Co. Ricardo Morales - President. Audrey Moran -. Museum of Contemporary Art Jacksonville Mrs. Caitlin Doherty - Executive Director.

MW Builders, Inc. Isaac Byers - Division Manager. NAI Hallmark Ms. Nemours Dr. Michael Erhard - Chief Medical Officer. Alex Jenkins - Sales Consultant. Newfold Digital Ms. Christina Clohecy - CFO. Stacy Blair - Regional Manager. Robert Williams - Senior Plant Director. Nimnicht Family of Companies Mr. North Florida Land Trust Ms. North Florida Sales Mr. Erik Joyner - Marketing Manager. Northwell Health Mr. Derrall Allen - Director of Operations.

Grady Hebert - Vice President, Operations.

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Aetna Inc. The information you will be accessing is provided by another organization or vendor. If you do not intend to leave our site, close this message. Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan.

Do you want to continue? The Applied Behavior Analysis ABA Medical Necessity Guide helps determine appropriate medically necessary levels and types of care for patients in need of evaluation and treatment for behavioral health conditions.

Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.

Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.

The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered i. The member's benefit plan determines coverage.

Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. Copyright by the American Society of Addiction Medicine. Reprinted with permission.

No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". See Aetna's External Review Program. All Rights Reserved. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins CPBs solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc.

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No fee schedules, basic unit, relative values or related listings are included in CPT. The responsibility for the content of this product is with Aetna, Inc. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

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Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. This information is neither an offer of coverage nor medical advice.

It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern. Working with us. Join our network. Confirm patient eligibility Precertification lists and CPT code search. Existing health care professionals.

Availity provider portal Update your data Utilization management Provider referral directory. Electronic claims. Disputes and appeals. Cost estimator and fee schedules. Pharmacy claims. Dental claims. Pharmacy services. Update pharmacy data. Find prescription drug coverage. Clinical policy bulletins. Clinical policy bulletin overview Medical clinical policy bulletins Dental clinical policy bulletins Pharmacy clinical policy bulletins.

Medicare resources. Education, trainings and manuals. Overview Educational webinars Provider manuals Behavioral health trainings. State regulations Federal regulations. News and Insights. OfficeLink updates newsletter. Company news.

Existing health care professionals Availity provider portal Update your data Utilization management Provider referral directory. Pharmacy Pharmacy services Update pharmacy data Find prescription drug coverage. Resources Clinical policy bulletins Clinical policy bulletins Clinical policy bulletin overview Medical clinical policy bulletins Dental clinical policy bulletins Pharmacy clinical policy bulletins. Education, trainings and manuals Overview Educational webinars Provider manuals Behavioral health trainings.

Regulations State regulations Federal regulations. Digital authorization status letters PDF Clinical questionnaire When you submit a prior authorization request for certain services, we may pend your request for additional clinical information.

All the tools you need, all in one place. All the tools you need, all in one place The Aetna provider portal on Availity helps you spend less time on administration so 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 claims Get authorizations and referrals Check patient benefits and eligibility Upload medical records and supporting documentation File disputes and appeals Update your information You can also stay up to date with the latest applications, resources and news from us.

How to get started. How to get started If your practice already uses Availity, simply contact your Availity administrator to request a username. Set up Availity account Need help registering for Availity? Browse tips, webinars and training to get on board. Availity registration resources. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals.

BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer. Welcome Employers Producers Providers. Pharmacy Pharmacy Dispensing Quantity vs. To learn more about checking eligibility and benefits via Availity, refer to the Eligibility and Benefits User Guide. Authorizations managed by eviCore healthcare eviCore are handled through the eviCore portal.

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Overview Educational webinars Provider manuals Behavioral health trainings. State regulations Federal regulations. News and Insights. OfficeLink updates newsletter.

Company news. Existing health care professionals Availity provider portal Update your data Utilization management Provider referral directory. Pharmacy Pharmacy services Update pharmacy data Find prescription drug coverage. Resources Clinical policy bulletins Clinical policy bulletins Clinical policy bulletin overview Medical clinical policy bulletins Dental clinical policy bulletins Pharmacy clinical policy bulletins.

Education, trainings and manuals Overview Educational webinars Provider manuals Behavioral health trainings. Regulations State regulations Federal regulations. Digital authorization status letters PDF Clinical questionnaire When you submit a prior authorization request for certain services, we may pend your request for additional clinical information. All the tools you need, all in one place. All the tools you need, all in one place The Aetna provider portal on Availity helps you spend less time on administration so 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 claims Get authorizations and referrals Check patient benefits and eligibility Upload medical records and supporting documentation File disputes and appeals Update your information You can also stay up to date with the latest applications, resources and news from us.

How to get started. How to get started If your practice already uses Availity, simply contact your Availity administrator to request a username. Set up Availity account Need help registering for Availity? Browse tips, webinars and training to get on board. Availity registration resources.

Working with Aetna educational webinars. Register for a live webinar. Availity portal resources and educational materials. Refer to these helpful resources to better navigate Aetna functionality on Availity. Need help? Legal notices Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates Aetna.

Health benefits and health insurance plans contain exclusions and limitations. See all legal notices. You are now being directed to the AMA site Links to various non-Aetna sites are provided for your convenience only.

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Login Please log in to your secure account to get what you need. You are now leaving the Aetna Medicare website. Error or missing data. Please check your entries for an error message. This search uses the five-tier version of this plan Each main plan type has more than one subtype.

I Accept. I accept. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members.

Not all plans are offered in all service areas. All services deemed "never effective" are excluded from coverage. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Visit the secure website, available through www.

CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool.

No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc.

Disclaimer of Warranties and Liabilities. Treating providers are solely responsible for dental advice and treatment of members. While the Dental Clinical Policy Bulletins DCPBs are developed to assist in administering plan benefits, they do not constitute a description of plan benefits.

The Dental Clinical Policy Bulletins DCPBs describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information.

Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered i.

Your benefits plan determines coverage. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Since Dental Clinical Policy Bulletins DCPBs can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies.

Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. Aetna Clinical Policy Bulletins CPBs are developed to assist in administering plan benefits and do not constitute medical advice.

Members should discuss any Clinical Policy Bulletin CPB related to their coverage or condition with their treating provider. While the Clinical Policy Bulletins CPBs are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Clinical Policy Bulletins CPBs express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic.

Aetna has reached these conclusions based upon a review of currently available clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors.

Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins CPBs. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins CPBs , including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame.

Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services.

New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission. Unlisted, unspecified and nonspecific codes should be avoided. If there is a discrepancy between a Clinical Policy Bulletin CPB and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members.

Since Clinical Policy Bulletins CPBs can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies.

While Clinical Policy Bulletins CPBs define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision.

However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA e. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.

Welcome Employers Producers Providers. Pharmacy Pharmacy Dispensing Quantity vs. To learn more about checking eligibility and benefits via Availity, refer to the Eligibility and Benefits User Guide. Authorizations managed by eviCore healthcare eviCore are handled through the eviCore portal. Predetermination of benefit requests may be submitted via Availity, or by fax or mail using the appropriate form in the Forms section.