The "yearly visit limit" seems to be age-based. However, the policy isn't completely clear as to what at date we should be computing the patient's age. The encoding currently uses the patient's age at the time of the claim, which I don't believe is correct.
Instead, I think we should use the patient's age at the time of the visit. However, this isn't disambiguated in the policy wording. So, until we get an answer from Aetna, we should leave a note that this is a decision we're making. Once we get an answer from Aetna clearing this up, we should update the encoding and update the note to mention that our encoding is based on their disambiguation.
The "yearly visit limit" seems to be age-based. However, the policy isn't completely clear as to what at date we should be computing the patient's age. The encoding currently uses the patient's age at the time of the claim, which I don't believe is correct.
Instead, I think we should use the patient's age at the time of the visit. However, this isn't disambiguated in the policy wording. So, until we get an answer from Aetna, we should leave a note that this is a decision we're making. Once we get an answer from Aetna clearing this up, we should update the encoding and update the note to mention that our encoding is based on their disambiguation.