October 1, 2007

Dear Health Care Professional:

Pilot program launching soon – notification of in-network referral to Aetna is not needed
Beginning January 1, 2008, as part of a pilot program in select markets, referrals (paper or electronic) are no longer required when patient care is coordinated between primary care physicians (PCPs), in-network specialists and providers whose services do not require precertification. Please continue to direct patients for care, but submitting a referral to Aetna is not needed.

This pilot program will begin in Dallas, TX and Atlanta, GA. To ensure the rollout is as smooth as possible for you and your patients, we’ll notify you of any changes and/or updates as they arise.

During the pilot period, we may need to request information from you regarding the coordination of patient care. Throughout the pilot, we will re-evaluate the effectiveness of the pilot, taking into consideration feedback we receive from the provider community.

What this means to you
 PCPs will:

• Coordinate patient care by directing/referring patients to in-network specialists
• Discontinue submitting referrals (paper or electronic) to Aetna for those patients

Please remember to direct patients to in-network providers. Directing patients to nonparticipating providers will require prior authorization in order to be covered on an in-network basis. Failure to preauthorize could result in payment denials or a reduction in the benefit payable and increased costs for your patients.

Specialists will:

• Continue to receive Aetna patients, as directed/referred by their PCP
• No longer need to verify Aetna referrals (paper or electronic) for those patients
• Adhere to current claim guidelines, including lab services that may be performed in office

We’re here to answer your questions
If you have questions regarding this matter, please contact our Provider Service Center by calling:

• 1-800-624-0756 for HMO-based benefits plans
• 1-888-MDAetna (1-888-632-3862) for indemnity and PPO-based benefits plans

Sincerely,
 
Sheila Ware
Network Vice President