Provider Look Up Tools Broker Training

Transcription

1 September 2018 Provider Look Up Tools Broker Training Aetna DocFind and Aetna-Coventry Provider Lookup Aetna Pharmacy Help Network & Preferred Pharmacy Finder 1

2 How to look up in-network providers Important Please read: We have two provider search sites: Aetnamedicare.com and Coventry-medicare.com It s important to use the correct site to determine which providers are in network based on your plan Remind and encourage your clients to use the site corresponding to their plan Aetnamedicare.com If you have an Aetna branded plan, use the Aetnamedicare.com/findprovider How to determine an Aetna branded plan - use the First look tool by putting in your plan name Coventry-medicare.com If you have an Aetna Coventry branded plan, use the Coventrymedicare.com/findprovider How to determine an Aetna Coventry branded plan - Use the First look tool by putting in your plan name Example: Look for the branding / logo. Aetna branding suggests using the Aetmamedicare.com site The Aetna Coventry branding / logo suggests using the Coventry-medicare.com site 2

3 Tips and helpful hints We believe the new redesign will streamline your provider searches. Here are some helpful hints before we begin.. Delete any older/saved favorite links and clear your browser/cache history Save new links to your favorites (see below) Always verify you are using the correct site (Aetna or Aetna-Coventry) Always use these links for your searches During AEP, a provider lookup hotline will be available for Ready to Sell brokers Representatives will be available 7am 7pm (CST) October 1 December 7,

4 How to use Aetna s Doc Find September 20184

5 Aetna in network provider look up - DocFind Save this link to your favorites, and use it for quick access into our search tool, DocFind, to verify in-network provider participation Enter into the search as a Guest the second box for providers, or the third box for pharmacies The DocFind site is for use with Aetna brand MAPD (or PDP for pharmacy only searches). 5

6 Aetna in network provider look up - DocFind Select the plan year and type of search you want (Individual or Group) It is important to select the correct search in order to return accurate results There is no need to login or register, go to the right side of the page and click the link for Medicare plans you purchase yourself Keep in mind you will not see both plan years until 10/1/18 (2018 and 2019) 6

7 Aetna in network provider look up - DocFind Enter the zip code of the client s home/permanent residence Select the box on the left Select plan to find providers If the zip code you enter crosses more than one county, you will be prompted to select the appropriate county remember we want to search for participating providers in the client s plan for accuracy, please make it a habit to use this search box however, you can skip plan selection (box on the right side) 7

8 Aetna in network provider look up - DocFind Select the plan type you are looking for. Keep in mind, our plans are MEDICARE ADVANTAGE PRESCRIPTION DRUG plans (MAPD) - Medicare Advantage plan refers to MA only type products 8

9 Aetna in network provider look up - DocFind Select the plan type you are searching. Keep in mind this is plan specific, plans may use different provider networks. If you need to isolate optional supplemental benefit networks (such as dental) please select the dental option. Once you select the plan (HMO, PPO, or Dental) please click the box in the lower right corner at the bottom of the page continue to find care 29

10 Aetna in network provider look up - DocFind In the provider search box you can search by name, specialty. You can also search by Category. Click the specialty category you are looking for to find participating providers 10 29

11 Aetna in network provider look up - DocFind REMEMBER: Sometimes providers are contracted under their group name Always put the Primary Care ID on the enrollment application You can alter the distance to show results in a more narrow distance range Review See Accepted Plans for further details on the provider 11

12 Aetna in network provider look up - DocFind To continue searching for additional providers, go to the top of the screen and click find provider and continue to search as shown on the prior slide. You do not have to start over, just continue on in the site

13 How to use Coventry s Provider Look Up March

14 Coventry in network provider look up Save this link to your favorites, and use it for quick access into our Coventry Provider Look up tool, to verify innetwork provider participation Choose your location (this pull down feature will allow you to choose the State in which you are searching for a provider If you want to search Pharmacies, Dentists, or Mental Health providers, click on that direct link - Found under the choose your location dropdown 14

15 Coventry in network provider look up Enter the zip code or search by county of the provider you are looking for Enter the name of the provider, facility, or specialty that you are searching You can also click into the specific category that you are searching - e.g. Providers or Conditions 15

16 Coventry in network provider look up The results will return in alphabetical order, within the zip code radius default You can narrow your results on the left side of the screen - Mile radius - Accepting new patients - Provider gender 16

17 Coventry in network provider look up REMEMBER: Click on More about this provider to view the Primary Care ID Always put the Primary Care ID on the enrollment application Review Overview for further details on the provider 17

18 Pharmacy Look Up Preferred Network Standard Network March 2018

19 Aetna in network provider look up Enter the client zip code to find network pharmacies IMPORTANT REMINDER : members may be able to get a 90-day fill of their medication at a local retail pharmacy or Aetna Rx Home Delivery (mail order). However, please let your clients know if their medication is in a classification that does not allow a 90-day fill, that the pharmacy (retail and/or mail order) will only fill the allowable days. Please see the formulary or drug look up tools for any requirements on specific medications KEEP IN MIND: Our Aetna Medicare Select Rx (PDP) has a more limited network than other plans (for example, it does not include Walgreens). 19

20 Aetna in network provider look up In the center of the page, select which plan group you are looking for (Medicare Advantage Prescription Drug Plans) or (Prescription Drug Plans) Then select Find Pharmacy 20

21 Aetna in network provider look up Local in-network retail pharmacies will be listed How to identify preferred vs standard retail pharmacies - Look at the number on the left side of the page next to the pharmacy name ORANGE numbers are preferred and will extend preferred pricing options to members BLUE numbers are standard pharmacies standard pharmacies are in-network, however the member cost share can be higher than what a member incurs at a preferred pharmacy 21

22 Aetna in network provider look up Information about the retail pharmacy is listed in the column next to the pharmacy name/address Continue to move through the page numbers for additional in-network pharmacies ORANGE numbers are preferred and will extend preferred pricing options to members BLUE numbers are standard pharmacies standard pharmacies are in-network, however the member cost share can be higher than what a member incurs at a preferred pharmacy 22

23 Who to contact for help Questions or need help We are here to help. Please contact the Broker Services Department Call: Download a provider directory Please Note: Our networks change throughout the year. If you download a provider directory, please encourage your clients to verify participation before enrolling in a plan or visiting the doctor, with our online tools or by calling us. 23

24 Thank you If you have questions please contact your local Broker Manager or Broker Support September