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Thread: Aetna guidelines for PCP

  1. #1

    Cool Aetna guidelines for PCP

    AAPC: Back to School
    HI,does anyone know the guidelines for Aetna HMO when it comes to changing pt PCP ? We had services done in last year. Claims are not paid. I called Aetna and was told that they have a 60 days after DOS to change their PCP provider. I know there is also a way to get guidelines on NaviNet but I have no Idea how to get there can you please help me ? I need to have it done by next friday

  2. #2


    Hi, The pt just needs to log on to their Aetna website and ask to change PCP. It's three easy steps and its' done. You can also log on to Navinet and enroll. Hope this helps. Suzanne

  3. #3

    Cool aetna hmo

    Hi and thank you ......but what I am looking for is ...some guidelines . Lets say pt with HMO plan has pcp listed as Dr. Feelgood . Cannot get to see him so has to go to the walk in. Aetna will not pay the claim because pt did not have a refferal . That makes sense I just need to support my thoughts with guidelines...............

    thank you much

  4. #4
    Join Date
    Apr 2007


    If a patient has to go to a Walk in, this sounds like emergency visit, and it would fall under the "emergency rules". No referrals are needed for emergencies. Aetna's definition of "emergency" may be in their guidelines or they may use the same as Medicare.

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