Aetna – New Pre-approval Requirements for Alabama, Arkansas, Louisiana and Mississippi Commercial Members

Our Enhanced Clinical Review program with eviCore healthcare will require pre-approval for certain procedures. The program will start on November 1, 2021. It affects Alabama, Arkansas, Louisiana, and Mississippi members in our fully insured and self-insured commercial HMO/PPO Aetna® products.

Services that require pre-approval:

• High-tech outpatient diagnostic imaging procedures such as MRI/MRA, nuclear cardiology, and PET scan and CT scan, including CTA
• Nonemergent outpatient stress echocardiography
• Nonemergent outpatient diagnostic left and right heart catheterization
• Insertion, removal and upgrade of elective implantable cardioverter defibrillator, cardiac resynchronization therapy defibrillator and implantable pacemaker
• Polysomnography (attended sleep studies)
• Interventional pain management
• Radiation therapy services (for fully insured members only) — these include complex and 3D conformal; Stereotactic Radiosurgery (SRS)/Stereotactic Body Radiation Therapy (SBRT); brachytherapy; hyperthermia; Intensity-Modulated Radiation Therapy (IMRT)/Image Guided Radiation Therapy (IGRT); proton beam therapy; neutron beam therapy; and radiopharmaceuticals