Aetna Implementation Resources
myNEXUS is proud to announce its partnership with Aetna to provide utilization management for home health services in Texas.
- Important COVID-19 Information: With the heightened international awareness regarding the coronavirus disease of 2019 (COVID-19), myNEXUS would like to provide important reminders for your agency. Please find the myNEXUS announcement regarding these reminders on business disruption, which includes infectious outbreaks and other occurrences that potentially impact all of us and consequently, our members/your patients located online here.
Effective March 1, 2020, myNEXUS will manage Aetna Medicare Advantage (MA) plans in the state of Texas. Delegated services include Claims Payment, Provider Network, and Utilization Management.
Home health-related requests for in-home skilled nursing, physical therapy, occupational therapy, speech therapy, home health aide, and medical social work will now require pre-authorization from myNEXUS. Claims for home health services for Aetna Medicare Advantage Members will also be paid by myNEXUS. This will occur for services administered in a home or residence for Aetna Medicare Advantage members in Texas.
Please follow the links below for program materials:
myNEXUS utilizes CMS National and Local Coverage Determinations (NCD and LCD’s) when applicable, or Aetna medical policies and clinical Utilization Management guidelines to facilitate appropriate evaluation of medical necessity by including assessment of the member throughout the continuum of care. A synopsis of the criteria is available to Providers and Members on request and free of charge by calling myNEXUS at 844-411-9622 or by emailing provider_network@myNEXUScare.com.
Provider Authorization Portal