Aetna CPT® Code Pre-Authorization Process Recommendations

Some Aetna insurance plans have implemented a pre-authorization process based both on units and specific CPT® codes. We created the following workflow recommendations to help WebPT Members affected by these new requirements. If your practice is affected, we also recommend reviewing Aetna’s Precertification Lists page to see which CPT® codes require pre-authorization.

WebPT EMR Users

For Members using the WebPT EMR, we recommend the following:

• Front office staff can enter the authorized CPT® codes and units—along with expiration dates—into each patient’s case in the Additional Info field. This will allow the information to display in the upper-right area of the patient record for easy reference.
• Staff should update this field whenever an authorization is updated.
• Ideally, this field can be updated after every visit during which the therapist documents and bills codes/unit. Otherwise, the therapist will need to be manually notified by billing or support staff when they’re about to run out of codes/units.

To update the Additional Info field:

1. Navigate to the patient’s chart.
2. Select Patient Info.
3. On the Cases tab, select the edit icon next to the corresponding case.
4. Locate the Additional Info field and enter the authorization information, as shown below.
5. Click OK, followed by Save Patient.

WebPT EMR + RevFlow Users

For Members using WebPT EMR for documentation and RevFlow/WebPT Billing for billing, we recommend the following:

• The individual responsible for authorizations should access each affected patient's billing register in RevFlow/WebPT Billing, which shows what was included on the submitted claim after scrubbing.
• To ensure the claim generation cycle is complete, wait at least one business day after the patient's visit note is finalized.

Click here to access a spreadsheet you can use to compare what was submitted on the claim against what was authorized.

• The spreadsheet is pre-loaded with an example for illustrative purposes only.
• Formulas are embedded in the spreadsheet for auto-deduction of units.
• Additional rows can be inserted as needed.
• Given the likelihood of multiple authorizations within the same case, we recommend using one spreadsheet per patient.
• Once the patient’s episode of care is complete, we recommend uploading the spreadsheet into either the eDoc section of the patient chart (in the WebPT EMR) or the scanned documents section of RevFlow/WebPT Billing.

As claims are submitted, remaining authorization information can be conveyed to the therapist either by updating the fields identified above or via a manual process of the therapist’s choosing.

Limitations:

• This is a forecasting approach only, as we don't have real-time claim adjudication to reconcile against.
• Enforcement of timely note completion and finalization is essential to have any information to track from the billing register.

Information will not be in the billing register if:

• Members choose to hold claims on claim delay,
• Claims are going on claim delay for one of our automated reasons, or
• Members hold on the charge audit screen for a set number of days.

Analytics Reporting Option

Let’s review how to manipulate the Documented Units report in Analytics to help you track patient progress toward unit and CPT® Code authorization limits.

Building the Report

1. Start by opening your Analytics portal.
2. In the Reports section, select Documented Units.
3. Set the desired Date Range.
4. Click on Primary Insurance and select Filter.
5. Select In List from the Comparison drop-down, use the… menu to open the Select a Value window. In this section, select the insurances that require pre-authorization. Click Add.
6. Click on the Patient Name field and select Group.
7. Alternative: if you want to report on a specific patient, select Filter instead of Group, change the Comparison drop-down to Contains, type in the patient’s name (you must type it exactly as it appears in Analytics), and click Add.
8. Next, click on the CPT Code field and select Group.
9. Then, click on Units, hover over Aggregate, and select Sum.
10. You may need to drag the Units section next to the CPT Code column to view the data more easily. Click on the edge of the Units column and drag.
11. Now, you can quickly see the total number of units billed for each CPT Code for each patient.
12. To collapse unnecessary rows, click the Gear Icon, click on Group, select Exclude Detail Rows.