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Aetna New Pre-Auth Process & Pre-Auth Denials

Many members have received a letter from Aetna regarding a new pre-authorization process coming January 1, 2019.  Aetna’s contract with Triad/eviCore is expiring on December 31, 2018.  A vendor called National Imaging Associates (NIA) will be managing this new pre-authorization program immediately following the Triad contract expiration.  The process will apply to all physical medicine procedure codes regardless of what type of provider performs them whether it be a DC, PT or MD.  The pre-authorization program will be applied to in-network providers on fully funded plans only.  

This new process was implemented in New York, Pennsylvania, Delaware and West Virginia as of September 1st.  We have been in contact with several of these associations as well as the ACA to form a collective response to these changes.  We are gathering information and details on how the process is working in actual practice.  We are also working with Aetna to fully understand the process and work towards solving any implementation problems that have occurred in the active states thus far. 

 We have also heard from many members that they have been receiving denials for lack of pre-authorization here in New Jersey since around the beginning of September.  We have reached out to Aetna to investigate these denials.  They have confirmed that there should be no pre-authorization requirements in NJ at this time but are still investigating the cause of these denials.  If you have received such a denial, please reach out to me at

 Some members have reported seeing pre-authorization requirements listed on Navinet.  Aetna has advised that some displays in Navinet are broadly applied to multiple specialties or states.  Aetna suggests checking if specific CPT codes require precertification here.