Meritain Prior Authorization List (2024)

FAQs

Are Aetna and Meritain the same? ›

We take pride in being one of the nation's largest third party administrators (TPAs), and a subsidiary of Aetna® and Fortune 6 company CVS Health®.

If you have any questions about precertification, just call our Meritain Health Medical Management team at 1.800. 242.1199.

Exclusive: Members fill specialty medication exclusively through the CVS specialty pharmacy or their local CVS pharmacy. Open: Members fill specialty medication at any pharmacy.

Solutions from Meritain Health®

Our broad network option—Aetna Choice®​ POS II network—gives you access to a full,​ nationwide network with carrier-level discounts. ​We're the only third party administrator (TPA) able to offer this network.

Meritain Health offers medical plans through the Aetna national network of doctors and hospitals.

With 40 years of excellence as a third party health care benefits administrator and a proud subsidiary of Aetna® and Fortune 4 company CVS Health®, Meritain Health® delivers customized, cost-effective and convenient solutions.

Requesting authorizations on Availity* is a simple two-step process. Here's how it works: Submit your initial request on Availity using the Authorization (Precertification) Add transaction. Complete a short questionnaire, if asked, to give us more clinical information.

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.

No. You can see the specialist you choose without a referral. All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies. Preventive care/screening/ immunization No Charge Not Covered You may have to pay for services that aren't preventive.

The journal recently released rankings for 2021, and we are again well-positioned in our industry. For TPAs who focus solely on employee benefits and claims handled for employees, we're pleased to have ranked in the number two spot¹.

Who is the pharmacy benefit manager for Meritain Health? ›

Prescription benefits for Meritain Health members are administered by CVS/Caremark. Your prescription benefit is designed to bring you quality pharmacy care that will help you save money.

Once you've met your Meritain plan deductible, authorized fertility services will be covered at 90%.

Now a subsidiary of Aetna® and Fortune 4 company CVS Health®, we're able to help more customers reach their self-funded goals. We also support 1.5 million members, helping them live healthier lives—just as we've done since 1983.

Aetna® is proud to be part of the CVS Health family.

Remember, Aetna and Coventry are the same company, so you and your patients may see either name or logo on the communications we send to you. We're always working to improve your experience. So if you have any questions or concerns, please call us. You can reach us at the number on your patients' ID cards.

2017: On December 3, 2017, CVS Health announced the acquisition of Aetna for $69 billion. Larry Merlo became chief executive of the two brands. Aetna CEO Mark Bertolini resigned and Aetna President Karen S.