Aetna
Welcome to the Aetna page. Here you can access useful materials about the program.
Aetna has selected National Imaging Associates, Inc. (NIA) to provide utilization management for physical medicine. Beginning September 1, 2018, for Delaware, New York, Pennsylvania and West Virginia, providers must request prior authorization for physical therapy, occupational therapy and chiropractic services through NIA at RadMD.com.
Refer to the state-specific CPT Matrix document below to view specific codes managed by NIA.
If you have any questions about the NIA Program, please contact your dedicated NIA Provider Relations Manager:
- Delaware: Charmaine Everett
- New Jersey: Seth Cohen
- New York: Seth Cohen
- Pennsylvania: Seth Cohen
- West Virginia: Seth Cohen
News and Updates
Recording of Aetna Physical Medicine Update Provider Training - New
Aetna Total Number of Units Provider Update - Effective November 9, 2020
Aetna Total Number of Units FAQ Update - Effective November 9, 2020
Aetna Total Number of Units Provider PowerPoint Update - Effective November 9, 2020
New Prior Authorization Requirement - Effective August 31, 2020
Physical Medicine
Beginning September 1, 2018, any provider that is performing physical therapy, occupational therapy or chiropractic services must contact NIA for prior authorization. (Delaware, New York, Pennsylvania, West Virginia)
Prior authorization will be required for Aetna New Jersey and western New York effective January 1, 2019.
Effective August 1, 2019, CPT Codes 98925 - 98929 for Osteopathic Physicians do not require prior authorization for Aetna Members.
Delaware
- Delaware PT, OT and Chiropractic Letter
- DE Physical Medicine CPT Matrix 2020 (Effective November 9, 2020)
- DE Physical Medicine Updated QRG - New
- DE Physical Medicine Updated FAQ - New
- DE Physical Medicine Updated Provider Education PowerPoint - New
- Physical Medicine Updated Tip Sheet/Checklist - New
- RadMD Requesting Additional Physical Medicine Units
- Recording of Aetna Physical Medicine Update Provider Training - New
- Recording of Aetna Webinar Training
New Jersey
- NJ Annoucement Letter
- NJ Physical Medicine CPT Matrix 2020 (Effective November 9, 2020)
- NJ Physical Medicine Updated QRG - New
- NJ Physical Medicine Updated FAQ - New
- NJ Physical Medicine Updated Provider Education PowerPoint - New
- Physical Medicine Updated Tip Sheet/Checklist- New
- RadMD Requesting Additional Physical Medicine Units
- Recording of Aetna Physical Medicine Update Provider Training - New
New York
- NY Chiropractic Letter
- NY Physical Therapy and Occupational Therapy Letter
- NY Physical Medicine CPT Matrix 2020 (Effective November 9, 2020)
- NY Physical Medicine Updated QRG - New
- NY Physical Medicine Updated FAQ - New
- NY Physical Medicine Updated Provider Education PowerPoint - New
- Physical Medicine Updated Tip Sheet/Checklist - New
- RadMD Requesting Additional Physical Medicine Units
- Recording of Aetna Physical Medicine Update Provider Training - New
- Recording of Aetna Webinar Training
Western New York
- Western NY Combined Expansion Letter
- WNY Physical Medicine CPT Matrix 2020 (Effective November 9, 2020)
- Western NY Physical Medicine Updated QRG - New
- Western NY Physical Medicine Updated FAQ - New
- Western NY Physical Medicine Updated Provider Education PowerPoint - New
- Physical Medicine Updated Tip Sheet/Checklist - New
- RadMD Upload Feature
- RadMD Requesting Additional Physical Medicine Units
- Recording of Aetna Physical Medicine Update Provider Training - New
Pennsylvania
- Western PA PT, OT, Chiropractic Letter
- Eastern PA PT, OT, Chiropractic Letter
- PA Physical Medicine CPT Matrix 2020 (Effective November 9, 2020)
- PA Physical Medicine Updated QRG - New
- PA Physical Medicine Updated FAQ - New
- PA Physical Medicine Updated Provider Education PowerPoint - New
- Physical Medicine Updated Tip Sheet/Checklist - New
- RadMD Requesting Additionl Physical Medicine Units
- Recording of Aetna Physical Medicine Update Provider Training - New
- Recording of Aetna Webinar Training
West Virginia
- WV PT, OT Chiropractic Letter
- WV Physical Medicine CPT Matrix 2020 (Effective November 9, 2020)
- WV Physical Medicine Updated QRG - New
- WV Physical Medicine Updated FAQ - New
- WV Physical Medicine Updated Provider Education PowerPoint - New
- Physical Medicine Updated Tip Sheet/Checklist - New
- RadMD Requesting Additional Physical Medicine Units
- Recording of Aetna Physical Medicine Update Provider Training - New
- Recording of Aetna Webinar Training
Documents
RadMD User References
- RadMD Flyer
- Ordering Provider Access
- RadMD Quick Start Guide
- RadMD Upload Feature
- RadMD Physical Medicine Requesting Additional Units
- RadMD View Exam with Tracking Number
- RadMD Upload without Login
Recorded General Trainings
Recorded RadMD Demos
Physical Medicine Guidelines
Refer to the state-specific CPT Matrix document above to view specific codes managed by NIA.
MCG Guidelines®
- Magellan adopted the use of MCG Guidelines® for its Physical Medicine product. More information available here: /media/871888/instructions-for-accessing-mcg-guidelines-ambcare.pdf