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    v1.0.30
    OpenPayerLive policy feedClinical/Medical Policy

    Clinical/Medical Policy policy updates

    Track new and updated Clinical/Medical Policy policies impacting reimbursement and clinical operations.

    Policy Payer Type Specialty Change Effective
    Medical specialty medication quantity limits (selected agents)AetnaClinicalImmunology/RheumatologyModifiedApr 1, 2026
    Medical Specialty Medication Quantity Limits — Maximum Dosing RegimensAetnaClinicalImmunology/RheumatologyModifiedJan 1, 2026
    National Clinical Services (NCS) 600 — Transition/Continuity of Care Coverage (California Traditional Plans)AetnaClinicalPost-Acute & Facility CareModifiedNov 18, 2025
    Medical Specialty Medication Quantity Limits — Maximum Dosing Regimens and Quantity Limits (Actemra and multiple specialty medications)AetnaClinicalImmunology/RheumatologyModifiedOct 1, 2025
    Aetna Commercial Clinical Program Summary — Medical‑Benefit Drug List and Coverage GuidanceAetnaClinicalPharmacy & Specialty DrugsModifiedJul 1, 2025
    Transcranial Magnetic Stimulation (TMS) Precertification Information RequestAetnaClinicalPsychiatry/Behavioral HealthModifiedJan 31, 2025
    National Clinical Services (NCS) 600 Transition/Continuity of Care Coverage California HMO PlanAetnaClinicalPost-Acute & Facility CareModifiedJan 18, 2025
    Medicare Part B preferred drug list — Aetna Medicare Advantage (MA) only plansAetnaClinicalPharmacy & Specialty DrugsModifiedJan 1, 2025
    Medicare Part B preferred drug list — Aetna Medicare Advantage (MA) only plansAetnaClinicalPharmacy & Specialty DrugsModifiedJan 1, 2025
    Medicare Part B preferred drug list (MAPD only)AetnaClinicalPharmacy & Specialty DrugsModifiedJan 1, 2025
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    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.


    OpenPayer by Trek Health — Policy intelligence for billing and revenue cycle teams.
    Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.

    Where this data comes from

    Every entry in this feed comes from documents payers publish themselves: medical policies, provider bulletins, and clinical criteria. We check payer policy libraries daily and record the effective date on each update.

    See our data sourcesHow we process policy documents

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