Aetna US Healthcare & Aetna US Healthcare Medicare

Special Notes	Physician Service	Encounter Form Required Manual/Electric	Pre-Certification	Initiating Provider
Must Be Capitated	Primary Care	No	No
Must Be Capitated	Gerontology	No	No
Must Be Capitated	Pediatrics	No	No
Must Be Capitated	Care Clinic	No	No
	Specialty	Care Office	Visits
	Physician Service	Referral Form Required Manual/Electric	Pre-Certification	Initiating Provider
	Audiology	Yes	No	PCP
	Cardiology	Yes	No	PCP
	Dermatology	Yes	No	PCP
	Ear Nose & Throat	Yes	No	PCP
	GYN (2 visits per Year)	No	No
	Neurology	Yes	No	PCP
	Nutritional Counseling	Yes	No	PCP
	Oncology	Yes	No	PCP
	Ophthalmology	Yes	No	PCP
	Orthopedics	Yes	No	PCP
	Podiatry	Yes	No	PCP
	Surgery	Yes	No	PCP
	Urology	Yes	No	PCP

Gilda C. Chinnici, CHAM Permission Required © Riv. 5-99