CVS Health® provides the info on the next page. Aetna® is part of the CVS Health family of companies. If you want to stay on our site, choose the “X” in the upper right corner to close this message. Or choose “Go on to next website” to move forward to CVS.com.
2025
-
-
August 25, 2025
Vaccine Refusals Provider Notice (PDF)
August 21, 2025
Developmental Screening in the First Three Years of Life (DEV) (PDF)
New Policy Updates - Clinical Payment, Coding, and Policy Changes Effective October 1, 2025 (PDF)
July 22, 2025
Maternal Health Bills and Budget Items Effective July 1, 2025
July 17, 2025
Updates to the Mental Health Services Manual and Temporary Detention Orders Supplement
July 14, 2025
Updates to Chapter II of the Plan First Manual
July 9, 2025
July 7, 2025
Updates to the Addiction and Recovery Treatment Services (ARTS) Manual
July 1, 2025
Addiction and Recovery Treatment Services (ARTS) Rates Effective July 1, 2025
Physician Administered Drug Procedure Code Rate Additions Effective July 1, 2025
Nursing Facility and Specialized Care Rates Effective July 1, 2025
Outpatient Rehabilitation Rates Effective July 1, 2025
Resource Based Relative Value Scale (RBRVS) Rates Effective July 1, 2025
Clinical Laboratory Services Procedure Code Rate Additions Effective July 1, 2025
Waiver Rate Updates Effective July 1, 2025
June 25, 2025
Retraction Notice: Criminal Background Check (PDF)
June 23, 2025
Updated Provider Enrollment Requirements- Effective July 1, 2025
Personal Care Rate Updates Effective July 1, 2025
Home Health Rates Effective July 1, 2025
June 16, 2025
June 10, 2025
June 6, 2025
Retirement of Appendices D and E from the Pharmacy Provider Manual
June 4, 2025
Cardinal Care Implementation: Virtual Q&A Sessions
DMAS is inviting you to learn more about the new Cardinal Care Implementation planned for July 1, 2025.
DMAS and its MCOs will be hosting Virtual Question and Answer Sessions. There will be an opportunity to meet the health plans, ask questions, and learn important implementation details. You don’t have to register to join.
Date: Friday, June 13, 2025
Time: 10:00 AM – 12:00 PM
Join the 10:00 AM Microsoft Teams Meeting
Date: Friday, June 13, 2025
Time: 2:00 PM – 4:00 PM
Join the 2:00 PM Microsoft Teams Meeting
Submit your questions to DMAS prior to the event! The Cardinal Care FAQ will also be updated with additional information based on the questions received.
May 30, 2025
Provider Notification - Enhancing Claim Submission Capabilities Through Availity (PDF)
May 28, 2025
Provider Notification - Resubmission through Availity (PDF)
May 23, 2025
Updates to the Durable Medical Equipment and Supplies Manual Chapter IV
May 19, 2025
End of Flexibilities Under Section 1902(e)(14)(A)
May 15, 2025
May 12, 2025
Provider Notification - Criminal Background Screening Policy (PDF)
May 8, 2025
Update to Nursing Facility Manual Supplement: Protection of Residents’ Funds
April 29, 2025
Updates to Chapter 7 (Appendix D) of the Hospital Manual
April 11, 2025
Updates to Chapter V of the Psychiatric Services Manual
April 4, 2025
Updates to BabyCare Provider Manual Chapters 2 and 4
March 25, 2025
We have identified an issue with inappropriate claims denials for NDC. We have taken the necessary steps to resolve this issue within our system and are working on identifying the impacted claims. If you have claims that you believe were denied inappropriately, within the last year, related to NDC, please resubmit your claims accordingly using the appropriate form.
You may be able to best identify these claims by the following CARC and RARC on your remit:- CO16: Claim/service lacks information or has submission/billing error(s).
[Indent one more as a sub-bullet] * Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. - M119: Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC)
March 19, 2025
Notification of Licensing Status for 23-Hour Crisis Stabilization Services (PDF)
Notification of Licensing Status for Residential Crisis Stabilization Unit (RCSU) (PDF)
March 13, 2025
Updates to All Provider Manuals, Chapter 3 (Member Eligibility)
March 11, 2025
February 26, 2025
February 19, 2025
Provider Notification - New State Policies for Virginia Medicaid (PDF)
February 13, 2025
Updates to Rehabilitation Manual, Appendix D (Service Authorization)
February 11, 2025
Per Diem Inpatient Billing for Psychiatric and Rehabilitation Services – Effective
February 7, 2025
UPDATED: Implementation of New Front-End Editing Tool and Error Code Updates (PDF)
February 5, 2025
CPT® II Code Incentive Program Changes
From January 1 through December 31, 2024, Aetna Better Health of Virginia offered reimbursement for the utilization of specific Current Procedural Terminology (CPT) Category II codes. Providers were given the opportunity to earn an additional $25 by adding CPT II codes to claims.
The program has ended on December 31, 2024. No incentive will offered beginning January 1, 2025.
Claims for services provided in 2024 will continue to be eligible for incentive payment for all CPT® II codes. Note, however, claims run out will be accepted through February 1, 2025. Contact us if you have any questions on this change.
February 3, 2025
Updates to Brain Injury Services Targeted Case Management Supplement
January 21, 2025
January 16, 2025
Updates to the Service Authorization Appendix (Appendix C) of the Psychiatric Services Manual
January 15, 2025
Provider Notification - Implementation of New Front-End Editing Tool and Error Code Updates (PDF)
January 2, 2025
Plan First Program Changes Chapter IV
January 1, 2025
Consumer-Directed Work Shift Submission Requirements, Effective January 1, 2025
Transition of Service Authorization from DMAS to Acentra Health - effective December 1, 2024
- CO16: Claim/service lacks information or has submission/billing error(s).
2024
-
-
December 20, 2024
Update to Pending 1915(c) Home and Community-Based Services (HCBS) Waivers Amendments
December 19, 2024
Civil Money Penalty (CMP) Reinvestment Program Funding Opportunity
December 1, 2024
Transition of Service Authorization from DMAS to Acentra Health - effective December 1, 2024
November 26, 2024
Updates to the Residential Treatment Services Manual
Updates to the CCC+ Waiver Manual, Appendix D
November 25, 2024
Updates to Chapter 5 of the Hospital Manual
November 21, 2024
Updates to the Durable Medical Equipment Manual, Appendix D
November 20, 2024
Provider Notification - New State Policies for Virginia Medicaid (PDF)
Important Updates to NCCI Exclusion List and Billing Practices
We recently conducted an audit of our National Correct Coding Initiative (NCCI) exclusion list. When conducting this standard review, we made updates to codes that are identified as bundled, inactive or non-payable.
You may begin to see these updates on your current remits as recoupments, which is within policy and scope of ensuring best billing practices are followed. The standard process of submitting medical records for NCCI editing does apply, should you feel the denial is inappropriate. We thank you for your understanding.November 15, 2024
November 1, 2024
October 24, 2024
October 16, 2024
Continuous Glucose Monitoring (CGM) Criteria Update - Effective July 1, 2024
October 11, 2024
Updates to Chapter 6 of the Rehabilitation Manual
Aetna and Quest Analytics Partnership (PDF)
October 10, 2024
Vaccinations Available for Respiratory Syncytial Virus Season
Updates to the DD Provider Manual Chapter 4 and Appendix D
October 7, 2024
October 3, 2024
Change In Enrollment Policy for Certain Dual Eligible Medicare-Medicaid Enrollees
October 1, 2024
Children’s Vision Exams, Including Refraction – Effective July 1, 2024
September 17, 2024
Updates to Chapter 5 of the Local Education Agency Provider Manual (PDF)
September 16, 2024
Updates to Early Intervention Manual, Chapters 4, 5, and 6
September 12, 2024
End of COVID-19 Flexibilities: Vaccines and Testing Effective October 1, 2024
September 9, 2024
September 5, 2024
Clarification for Adults Enrolled in Dental Medicaid
August 27, 2024
Provider Reminder - CLIA Certificate Editing (PDF)
August 21, 2024
Updates to Brain Injury Services (BIS) Targeted Case Management (TCM)
August 20, 2024
Medicaid Durable Medical Equipment (DME) and Supplies Listing (PDF)
New Policy Updates - Clinical Payment, Coding and Policy Changes (PDF)
August 13, 2024
August 1, 2024
Implementing SNIP Type 4 Edits and Enhancing Claims Intake Editing at Types 1 – 4 (PDF)
July 25, 2024
July 8, 2024
Updates to the DD Waiver Provider Manual Chapter 2
Inpatient and Outpatient Hospital Rates Effective July 1, 2024
July 3, 2024
Pharmacy Manual Pharmacists as Providers Supplement Update
June 28, 2024
Inflation for Home Health Rates Effective July 1, 2024
Durable Medical Equipment Enteral Products and Supplies Rate Changes Effective July 1, 2024
Waiver Rate Updates Effective July 1, 2024
Nursing Facility and Specialized Care Rates Effective July 1, 2024
June 25, 2024
June 24, 2024
Ambulatory Surgical Center Reimbursement Effective July 1, 2024
Personal Care Rate Update Effective July 1, 2024
DMAS Pharmacy and Therapeutics (P&T) Committee Meeting Frequency
June 20, 2024
Changes to LTSS Screenings: PACE Sites Performing Screenings Effective 6/1/2024
June 11, 2024
June 3, 2024
Changes to LTSS Screenings: Nursing Facilities and Acute Care Hospitals
May 24, 2024
Update to Chapter 1 of all Provider Manuals
May 16, 2024
Updates to the Mental Health Services Manual
May 15, 2024
Provider Notification - Claims Payments (PDF)
May 13, 2024
Updates to the Telehealth Services Supplement
12-Month Continuous Eligibility (CE) for Children – Provider Manual Updates
May 9, 2024
Update to the Early Intervention ManualFee For Service Claims and Appeals
May 8, 2024
Updates to Chapter 5 of the Practitioner Manual
May 2, 2024
Updates to the Temporary Detention Orders (TDOs) Supplement
Enhanced Review Process for DRG Claims (PDF)
April 17, 2024
New Policy Updates - Clinical Payment, Coding, and Policy Changes Effective June 1, 2024 (PDF)
March 22, 2024
March 14, 2024
Updates to Chapter 6 of the CCC+ Waiver Manual
March 8, 2024
Effective May 1, 2024, the following Virginia Medicaid policy will be implemented:
Venipuncture: CPT Codes 36591 (Collection of blood specimen from a completely implantable venous access device) and 36592 (Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified) will deny incidental to the laboratory tests.
Modifiers 59, XE, XP, XS, and XU: Modifier 59, XE, XP, XS and XU will not bypass the daily unit limits editing logic.
National Correct Coding Initiative (NCCI): CPT Code 61783 will deny with any decompression procedure CPT Codes 63001-63053.
Evaluation and Management Services: E&M CPT Codes 99212-99215 and 99415-99417 will deny when billed with G2082/G2083 (Esketamine includes E&M services).
Contact Provider Relations at 1-800-279-1878 (TTY: 711) if you have any questions.March 6, 2024
Continuing Education and Training
Our Provider Engagement department, in partnership with our Quality team, has developed continuing education and training activities for providers. These courses are offered in conjunction with reputable organizations, and they have been specifically selected for their health equity and preventive care value.
Automated user-interactive provider training modules are now available for the below topics:- Healthcare Effectiveness Data and Information Set (HEDIS®)
- Culturally Linguistic and Appropriate Services (CLAS): Cultural Competency
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
By completing these classes online, you can earn free credits — at your convenience — in the privacy of your office or home. These enhanced educational, training, and reference materials were created for increased provider awareness and improved compliance with contractual requirements and regulatory standards.March 4, 2024
World HPV Day: What You Can Do (PDF)
February 29, 2024
Implementation Update for March 1, 2024: Legally Responsible Individuals
February 23, 2024
New Policy Updates - Clinical Payment, Coding and Policy Changes Effective March 23, 2024
We regularly augment our clinical, payment and coding policy positions as part of our ongoing policy review processes. In an effort to keep our providers informed, see the below upcoming new reviews.
Post-Acute Transfer: A post-acute care transfer occurs when an inpatient hospital stay is grouped to one of the qualifying post-acute DRGs and the patient is transferred/discharged to either a hospital or a distinct part hospital unit (inpatient rehabilitation facilities and units, long-term care, psychiatric, cancer or children’s hospitals), SNF, hospice, or home health.
These discharge status codes include 62, 63, 65, 05, 03, 50, and 06. The transferring hospital is paid based on a per diem rate up to and including the full DRG payment which may include a cost outlier payment if applicable.
February 2, 2024
Updates to the Pharmacy Provider Manual Appendix D and E
February 1, 2024
CXT New State Rules
On April 1, 2024, the following Virginia state policies will be implemented regarding coverage of RSV vaccination and preventive treatment:- Deny procedure code 90679 if patient age is less than 60
- Deny procedure code 90678 if patient age is less than 60 and correct diagnosis code is not found: Z3A.32, Z3A.33, Z3A.34, Z3A.35, and Z3A.36
Contact Provider Relations at 1-800-279-1878 (TTY: 711) if you have any questions.
Deletion of Renal Dialysis Clinic Manual
Deletion of Independent Lab Manual
January 29, 2024
Civil Money Penalty (CMP) Reinvestment Program Funding Opportunity
January 18, 2024
Update to Developmental Disabilities Waiver Manual – Chapter 5
January 4, 2024
Update to the Durable Medical Equipment and Supplies Provider Manual, Chapter IV
January 3, 2024
Provider Notification - Medicaid Precertification Optimization - Code Removals (PDF)
January 2, 2024
On February 3, 2024, the following Virginia state policy will be implemented regarding HCPCS codes S0280 and S0281:
- The unit of service for Case Management Assessment is one unit which equals one calendar month. A claim for the BIS TCM procedure code, S0281, cannot be submitted in the same month as the TCM Assessment code, S0280. The expected outcome would be to deny procedure code if submitted within the same calendar month as the support code (including the same day) by any provider.
Contact Provider Relations at 1-800-279-1878 (TTY: 711) if you have any questions.
2023
-
-
December 26, 2023
Updates to Pharmacy Manual Chapter 4 and a New Supplement to the Pharmacy and Practitioner Manuals
Personal Care Rate Update Effective January 1, 2024
Early Intervention Rate Update Effective January 1, 2024
Behavioral Health Service Rate Updates Effective January 1, 2024
December 15, 2023
December 12, 2023
All Providers Participating in the Virginia Medicaid and FAMIS Programs and Managed Care Programs
December 8, 2023
Patient Pay Underpayments - UPDATE
December 7, 2023
Update to Psychiatric Services Manual – Chapter 6
Update to Nursing Facility Manual – Chapters 7, 9, 10, and 11
December 6, 2023
December 4, 2023
*Important reminder: *Aetna Better Health of Virginia participating providers, by contract, are prohibited from billing any member beyond the member’s cost sharing liability, if applicable, as defined on the Aetna Better Health remittance advice. A provider may seek reimbursement from a member when a service is not a covered benefit and the member has given informed written consent before treatment that they agree to be held responsible for all charges associated with the service. If a member reports that a provider is balance billing for a covered service, the provider will be contacted by an Aetna Better Health Provider Relations Representative to research the complaint. Aetna Better Health is obligated to notify DMAS when a provider continues the inappropriate practice of balance billing a member.
December 1, 2023
Announcement New Brain Injury Services Case Management Service Begins on January 1, 2024
November 27, 2023
Coverage of Collaborative Care Management (CoCM) Services
November 16, 2023
Update to Legally Responsible Individuals: Implementation Delayed to March
Medicaid Home Health Care Services (HHCS) Electronic Visit Verification (EVV) Project Update
November 9, 2023
October 20, 2023
Coverage of RSV Vaccination & Preventive Treatment
Medicaid Pre-Pay Diagnosis-Related Grouping Review (Updated October, 2023) (PDF)
Medicaid Pre-Pay Diagnosis-Related Grouping Review Program FAQ (Updated October, 2023) (PDF)
October 17, 2023
October 6, 2023
Delay of the Implementation of Brain Injury Services Case Management Service
September 29, 2023
Update to Legally Responsible Individuals Rules Effective November 11, 2023
Provider Notification - Medicaid Precertification Optimization - Genetic Testing (PDF)
September 18, 2023
September 11, 2023
Update to Transportation Manual Chapter 4
August 30, 2023
Deemed Newborns Automated Process (PDF)
August 29, 2023
Coverage During the 90-Day Enrollment Grace Period
August 28, 2023
New Case Management Service for Persons with Traumatic Brain Injury
Update to Physician-Practitioner Manual, Chapters 4 and 5; and Hospital Manual, Chapter 5
August 23, 2023
New Policy Updates - Clinical Payment, Coding and Policy Changes Effective November 1, 2023 (PDF)
August 21, 2023
August 17, 2023
Minimum Data Set (MDS) changes effective October 1, 2023
Changes to Claims/Payment Process for Behavioral Health Providers- effective November 1, 2023
August 16, 2023
Managed care plans to assist enrollees in completing the Medicaid renewal process (PDF)
August 2, 2023
July 31, 2023
Update to Chapter 3 – All Manuals
July 27, 2023
Update to Nursing Facility Manual, Chapter 5
July 26, 2023
Patient Pay Underpayments Have Been Stopped
July 25, 2023
July 21, 2023
New Aetna Better Health Claims and Encounters Front End Edits (PDF)
July 17, 2023
New Policy Updates - Clinical Payment, Coding and Policy Changes Effective August 1, 2023 (PDF)
July 14, 2023
Home Health Rates Effective July 1, 2023
Inpatient and Outpatient Hospital Rates Effective July 1, 2023
Nursing Facility and Specialized Care Rate Updates Effective July 1, 2023
Outpatient Rehabilitation Rates Effective July 1, 2023
July 13, 2023
New Case Management Service for Persons with Traumatic Brain Injury
July 10, 2023
New Case Management Service for Persons with Traumatic Brain Injury (PDF)
July 6, 2023
Update to Chart of Provider Flexibilities
July 6, 2023
July 5, 2023
July 5, 2023
New Policy Updates - Clinical Payment, Coding and Policy Changes Effective September 1, 2023 (PDF)
June 30, 2023
Updates to the Pharmacy Provider Manual Appendix D and E
June 29, 2023
Processing and Payment of Emergency Room Claims Effective April 27, 2023
June 26, 2023
Provider Notification: Medicaid Precertification Optimization Code Additions (PDF)
June 23, 2023
Upcoming Changes to Service Authorization Criteria for Weight-Loss Drugs
June 22, 2023
The address change process for Aetna Better Health requires us to collect a W-9 for every Tax Identification Number (TIN) in our provider network.
Keep the following in mind to ensure your W-9 is accurate and is the most current form version available from the IRS.
1. The purpose of a W-9 is to inform payers of the name and address your TIN is registered with the IRS. If you are not sure what this is, reference a recent document sent to you by the IRS.
2. When completing your W-9:- Line 1 of the W-9 is mandatory.
- Line 2 of the W-9 is optional (DBA).
- The address on the W-9 can, but is not required, to match the billing address. Again, the W-9 address should be what the IRS has on file for the TIN, which may or may not be the same as your billing address.
- Ensure your W-9 matches exactly the way the IRS has your name and address listed, including abbreviations (St. vs. Saint, Road vs. Rd., Ste. vs. Suite, etc.).
- The W-9 must be signed and dated.
3. Should your W-9 name or address change, contact us,
Make sure your W-9 accurately reflects the information the IRS has on file for your TIN to prevent potential delays in reimbursement.
June 16, 2023
Notice of Kepro Rebranding to Acentra Health
June 14, 2023
Updates to Chapter IV, VI, and Appendix H of the Mental Health Services Manual
June 12, 2023
Updates to Residential Treatment Services Manual Chapter 6
June 7, 2023
Kepro’s Atrezzo Upgrading to Atrezzo Next Generation
June 5, 2023
Update to LTSS Services Manual Chapter 5
June 1, 2023
Medicaid Home Health Care Services (HHCS) Electronic Visit Verification (EVV) Project Update
May 30, 2023
CXT New State Rules
Effective July 1, 2023, the following new state policy will be implemented:- Procedure code 0114A will deny if greater than 11 years of age and less than 6 years of age.
- Procedure code 0164A will deny if greater than 5 years of age and less than 180 days of birth.
- Procedure code 0044A will deny if less than 18 years of age.
- Procedure code 0154A will deny if greater than 11 years of age and less than 5 years of age.
- Procedure code 0173A will deny if greater than 4 years of age and less than 180 days of birth.
- Procedure code 0134A will deny if less than 12 years of age.
May 22, 2023
Clinical Laboratory Improvement Amendments (CLIA) Requirements
As a reminder, the CLIA number must be included on each claim billed on the claim for laboratory services by any laboratory performing tests covered by CLIA. See §70.2 and 70.10 for more information. Effective July 1, 2023, claims will begin to deny if the required CLIA information is not included.The Clinical Laboratory Improvements Amendments of 1988, Public Law 100-578, amended §353 of the Public Health Service Act to extend jurisdiction of the Department of Health and Human Services to regulate all laboratories that examine human specimens to provide information to assess, diagnose, prevent, or treat any disease or impairment. The purpose of the CLIA program is to assure that laboratories testing specimens in interstate commerce consistently provide accurate procedures and services.
The CLIA mandates that virtually all laboratories, including physician office laboratories, meet applicable federal requirements and have a CLIA certificate in order to receive reimbursement from federal programs.
Learn more about this requirement.
May 19, 2023
Compliance with 21st Century Cures Act for MCO Network Providers (PDF)
May 18, 2023
Update to Psychiatric Services Manual Chapter 2
May 9, 2023
Updates to Chapter 2 of LTSS Screening Manual
May 8, 2023
New Emergency Medicaid Services Supplement
May 1, 2023
This notice is to inform providers of new state rules regarding COVID-19. Effective May 15, 2023, the following Virginia state policies have been implemented regarding COVID-19 services:
- Procedure codes 0041A, 0042A, 0124A will deny if patient is less than 12 years of age.
- Procedure code 0134A will deny if patient is less than 18 years of age.
April 26, 2023
New Policy Updates - Clinical Payment, Coding and Policy Changes Effective July 1, 2023 (PDF)
April 25, 2023
April 20, 2023
No Requirement for Exclusive Telemedicine Providers to Maintain a Physical Presence in Virginia
April 17, 2023
April 12, 2023
Effective May 10, 2023, the following Virginia state policies will be implemented regarding COVID-19 services:- Procedure codes 0041A, 0042A, 0124A will deny If patient is less than 12 years of age.
- Procedure code 0134A will deny if patient is less than 18 years of age.
For more information, contact Provider Relations at 1-800-279-1878 (TTY: 711).
April 10, 2023
Update to Chart of Provider Flexibilities
Notice of Award for RFP 2022-06 Service Authorization and Specialty Services Contract
April 7, 2023
Resource Disregard for Institutional and Community Based Waiver Services - REVISED
April 4, 2023
Temporary PACE Flexibilities Ending May 11, 2023
March 30, 2023
Return to Normal Enrollment – Frequently Asked Questions
March 28, 2023
Information on the Eligibility Renewal Process - REVISED
Fraud Alert Related to Eligibility Redeterminations
March 24, 2023
Information on the Eligibility Renewal Process
March 20, 2023
Office visit codes are being inappropriately denied due to a recent system update. This is currently being corrected and associated claims will automatically be reprocessed. Current remittance messages for office code denials may include:- "is denied according to VA State Medicaid Policy"
- "96 – Non-covered charge(s) – N216 – We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.”
March 13, 2023
Clinical Laboratory Improvement Amendments (CLIA) Requirements
As a reminder, the CLIA number must be included on each claim billed on the claim for laboratory services by any laboratory performing tests covered by CLIA. See §70.2 and 70.10 for more information.
The Clinical Laboratory Improvements Amendments of 1988, Public Law 100-578, amended §353 of the Public Health Service Act to extend jurisdiction of the Department of Health and Human Services to regulate all laboratories that examine human specimens to provide information to assess, diagnose, prevent, or treat any disease or impairment. The purpose of the CLIA program is to assure that laboratories testing specimens in interstate commerce consistently provide accurate procedures and services.The CLIA mandates that virtually all laboratories, including physician office laboratories, meet applicable federal requirements and have a CLIA certificate in order to receive reimbursement from federal programs.
Learn more about this requirement.
March 7, 2023
March 1, 2023
Revised Outpatient Hospital Rates – Effective July 1, 2022
A Provider’s Guide to Medicaid Redetermination: Fact Sheet and FAQ (PDF)
February 22, 2023
Return to Normal Enrollment Town Halls/Listening Sessions
February 16, 2023
Public Health Emergency Ends on May 11, 2023
Provider Notification - EFT ERA Registration Services (PDF)
February 14, 2023
February 7, 2023
Update to Durable Medical Equipment and Supplies Rates
February 6, 2023
Resource Disregard for Institutional and Community Based Waiver Services
January 26, 2023
Medicaid Home Health Care Services (HHCS) Electronic Visit Verification (EVV) Project Update
January 24, 2023
Income Disregard for Institutional or Home and Community Based Waiver Services
January 12, 2023
Updates to the Mental Health Services Manual
January 9, 2023
End of Continuous Coverage and Update on Provider Flexibilities
2022
-
November 3, 2022
Coverage of COVID services for Emergency MedicaidNovember 1, 2022
Updates to the Home and Community Based Services (HCBS) Developmental Disability Waivers Manual
October 5, 2022
July 27, 2022
June 10, 2022
One-time COVID-19 Support Payment for Attendant/Aides
April 22, 2022
Federal Public Health Emergency Extended & End of Nursing Facility Flexibility
March 8, 2022
The Department of Medical Assistance Services contracted with Myers and Stauffer, LC (MSLC) to conduct claims data analysis to identify eligible aides who qualify to receive the one-time COVID-19 support payment. MSLC will create a roster of the qualifying provider aide staff to the respective provider. Within 10 business days of receiving the roster from MSLC, each provider must supply the social security number for their aide staff appearing on their roster. This information uniquely identifies each aide to ensure that only one support payment is provided. As a result, each provider will receive a final roster of aides from MSLC who should receive the payment from the agency.
-
-
December 28, 2022
Face-To-Face Supervisory, Services Facilitation and ID/DD Case Management Visits January 1, 2023
December 21, 2022
Civil Money Penalty (CMP) Reinvestment Program Funding Opportunity
November 1, 2022
Updates to the Home and Community Based Services (HCBS) Developmental Disability Waivers Manual
December 16, 2022
Memo Implementation of ClaimsXten – Effective December 19, 2022
Introducing Waymark’s Community-Based Care Services
December 9, 2022
Increased Reimbursement of Medications for the Treatment of Opioid Use Disorder
December 7, 2022
Holiday Check Run Schedule
December
Christmas: There will be no changes to the schedule for December 19, 2022, through December 23, 2022. The Friday, December 23, 2022, check run will be dated Tuesday, December 27, 2022, per the routine process. This will be the last paid date of 2022 in support of the 1099 process.There will not be a check run on Monday, December 26, 2022. There will not be any check runs on Wednesday, December 28, 2022. There will be a check run for all plans on Friday, December 30, 2022, with a Tuesday January 3, 2023, paid date.
January
There will not be a check run on Monday, January 2, 2023. The Wednesday and Friday check runs for this week will run per the routine schedule.December 5, 2022
Updates to the Pharmacy Provider Manual Appendix D and E
December 2, 2022
November 22, 2022
October 24, 2022
Removal of Co-Payments for Medicaid and FAMIS Enrollees
October 18, 2022
Federal Public Health Emergency Extended Until January 11, 2023
October 13, 2022
October 4, 2022
Hospital & Ambulatory Surgical Centers (ASCs) 3M Grouper Updates (Effective July 1, 2022)
October 3, 2022
Reimbursement for a Telemedicine Originating Site Fee for Emergency Ambulance Transport Providers
September 21, 2022
Expanded Coverage of Preventive Services Available to Medicaid Adults
September 15, 2022
Medicaid Home Health Care Services Electronic Visit Verification Project Update
Updated Coverage of Screening for Lung Cancer with Low Dose Computed Tomography
September 12, 2022
New Policy Updates - Clinical Payment, Coding and Policy Changes Effective September 27, 2022 (PDF)
New State Policy Updates – COVID-19 Vaccine (PDF)
September 1, 2022
Updates to Comprehensive Crisis Services (Appendix G) of the Mental Health Services Manual
August 25, 2022
Update to the Nursing Facility Provider Manual Chapter
August 18, 2022
National Suicide Prevention Lifeline - Use “988” for Mental Health Support (PDF)
Providers, Register for the Provider Services Solution Portal (PDF)
August 16, 2022
August 5, 2022
August 1, 2022
Commonwealth Coordinated Care Plus Waiver Provider Manual—Chapters II and IV—and Forms Updates
July 18, 2022
Federal Public Health Emergency Extended Until October, 13, 2022
July 13, 2022
Inflation for Home Health Rates Effective July 1, 2022
Inflation for Outpatient Rehabilitation Rates Effective July 1, 2022
Personal Care Rate Update Effective July 1, 2022
Professional and Children’s Vision Rate Increases Effective July 1, 2022
Ambulatory Surgical Center Reimbursement - Effective July 1, 2022
Nursing Facility and Specialized Care Rate Updates Effective July 1, 2022
Hospital Reimbursement – Effective July 1, 2022
July 12, 2022
Update to the Durable Medical Equipment and Supplies Provider Manual, Appendix B Update
July 1, 2022
Updates to the Mental Health Services Manual
June 30, 2022
Coverage of COVID-19 Vaccine Boosters And Alternative COVID-19 Vaccine Formulations and Preparations
June 28, 2022
Peer Recovery Support Services Supplement
June 27, 2022
June 24, 2022
Changes in the Emergency Medical Certification process for Eligible Nonresident Aliens
Partnership with ProgenyHealth (PDF)
June 23, 2022
Virginia Department of Medical Assistance Services Community Doula Program
New Policy Updates – Clinical Payment, Coding and Policy Changes (Effective September 1, 2022) (PDF)
June 14, 2022
Updates to the HCBS Developmental Disability Waivers Manual Chapter 2
June 10, 2022
Update to the Pharmacy Provider Manual Chapter IV and Appendix D and Addition of Appendix E
New Guidance on Opioid Management for Medicaid Members (PDF)
Medicaid Long Term Services and Support Screening (LTSS) Training for Physicians
April 26, 2022
Medicaid Pre-Pay Diagnosis-Related Grouping Review (PDF)
Medicaid Pre-Pay Diagnosis-Related Grouping Review Program FAQ (PDF)
April 14, 2022
March 21, 2022
Attention providers! Aetna Better Health of Virginia has partnered with mPulse to provide a digital solution for conducting outreach to members for care/service reminders and education. The goal of this program is to improve quality metrics, including HEDIS measures, as well as member health outcomes, via a digital communication solution that contacts the member via text message. Aetna provides all funding for this program. Therefore, there is no risk nor cost to you.
If you are interested in learning more and participating in the program, please send us an email. We would love to hear from you!
March 18, 2022
March 17, 2022
Update - New Medicaid Enterprise System (MES) (PDF)
March 13, 2022
Provider Notification - Genetics Testing Policy Plus (PDF)
New Policy Updates - Clinical Payment, Coding and Policy Changes (PDF)
March 11, 2022
March 10, 2022
Update to the Durable Medical Equipment and Supplies, Appendix B Update
Medicaid Long Term Services and Support Screening (LTSS) Training Recertification Process
Medicaid Long Term Services and Support Screening (LTSS) Training for Physicians
Coverage of Remote Patient Monitoring/Update to Telehealth Services Supplement
March 8, 2022
One-time COVID-19 Support Payment for Attendant/Aides
March 4, 2022
DMAS Replacing VAMMIS With Medicaid Enterprise System (MES): Key Dates For Providers
February 23, 2022
Coverage of COVID-19 Oral Antiviral Products (Paxlovid and Molnupiravir)
February 22, 2022
Effective May 1, 2022, an authorization for observation services will no longer be provided to Aetna Better Health of Virginia contracted providers when an inpatient level of care has been denied. Authorization is not required for an observation stay with a contracted provider. The determination to bill for observation services can be determined by the contracted provider. All services, including Observation, provided by a noncontracted provider will continue to require an authorization.
February 16, 2022
Updated coverage of COVID-19 Antibody Products, Antiviral Products & Vaccine Booster Eligibility
February 15, 2022
February 4, 2022
Fee-For-Service Pause In Claims
This is an important update for fee-for-service Medicaid providers. As the Medicaid Enterprise System is prepared for launch, provider payments will briefly be paused from March 25 until April 4. We have carefully planned to make this transition as seamless as possible.
Medicaid providers can continue to submit claims during this period through electronic and paper transactions. You can continue to use the Medicaid provider portal for direct data entry of your claims through close of business on March 29, when the current portal will cease operations. A new Provider Services Solution (PRSS) portal will launch April 4.
We will hold and process all claims submitted during the transition and make payments beginning on April 15.
For example, some providers receive payment each Friday. Because of the transition, payments normally scheduled for Friday, April 1, will instead be made on Friday, April 15.
Providers who receive payments once a month will see no impact from this pause.
Once the new system launches, you will continue to submit claims in the same way you do today, with one change: You must assign taxonomy codes to claims starting April 4, 2022. Learn more about the new taxonomy code requirement here.
Please note that access to the current claims entry screens will be through the new PRSS portal beginning April 4, 2022.January 28, 2022
Updates to Coverage of COVID-19 Home Testing
January 19, 2022
Federal Public Health Emergency Extended Until April 16, 2022; New State Public Health Emergency
January 13, 2022
Temporary Virginia Public Health Emergency Due to COVID-19
January 1, 2022
2021
-
If you have questions related to COVID-19 flexibilities, just contact us.
August 29, 2021
COVID Flexibilities Update - Expiration of Grace Period on August 29, 2021 (PDF)
July 1, 2021
Updates to Coverage of COVID-19 Testing (PDF)
June 30, 2021
Developmental Disabilities (DD) Waivers Rate Updates Effective July 1, 2021 (PDF)
COVID Flexibilities Update – Expiration of State PHE on 6/30/2021 (PDF)
June 28, 2021
Coverage of COVID-19 Vaccine Administration for Plan First (PDF)
April 22, 2021
Updates to Coverage of COVID-19 Testing & Antibody Treatment (PDF)
April 1, 2021
Update to Reimbursement Rate for COVID-19 Vaccine Administration (PDF)
March 11, 2021 (PDF)
March 2, 2021
February 24, 2021
Update to Reimbursement Rate for COVID-19 Antigen Testing (PDF)
February 8, 2021
Updates to Coverage of High-Throughput COVID-19 Testing (PDF)
January 14, 2021
COVID-19 Flexibility Continuations Until 4/20/2021 (PDF)
January 11, 2021
January 7, 2021
January 5, 2021
-
-
November 11, 2021
Availity - A Better Solution for Your Faxing Needs (PDF)
November 9, 2021
Behavior Health Enhancement Codes Update Notification for BRAVO Phase 2 (PDF)
October 25, 2021
October 15, 2021
Outreach Underway for Letter Sent in Error to Some Members
If one of your patients received a letter titled "Premium Payment (Capitation Fees) for Managed Care Organization and Estate Recovery," please have them call 1-855-242-8282 (select Option 8). This letter was sent in error to some of our members by the Department of Medical Assistance Services and may impact their health coverage. Outreach is underway to address the matter. You can learn more here.
October 11, 2021
October 4, 2021
OBUS Implementation Template Guidelines (PDF)
October 1, 2021
New Prior Authorization Form Available Soon (PDF)
September 14, 2021
Migration to Change HealthCare’s ClaimsXten (PDF)
August 20, 2021
DMAS Notification - Paid Sick Leave for Consumer Directed Attendant (PDF)
DMAS Notification - Paid Sick Leave for Consumer Directed Attendant FAQs (PDF)
July 9, 2021
July 1, 2021
Durable Medical Equipment (DME) Updates (PDF)
June 29, 2021
Behavior Health Enhancement Codes Update Notification (PDF)
June 25, 2021
Notice on Philips Respironics Recall for DME Providers (PDF)
June 11, 2021
May 20, 2021
Durable Medical Equipment and supplies rate floor update (PDF)
May 14, 2021
New Appeals Information Management System (AIMS) Portal Streamlines the Appeals Process
The Virginia Department of Medical Assistance Services (DMAS) recently launched a new system and portal to manage the appeals process. The AIMS portal allows Medicaid members and providers the convenience of filing an appeal, submitting documents and monitoring the status of an appeal online throughout the appeal process.
When Medicaid members and providers in managed care programs file the first level of appeal, they will continue using our Aetna Better Health of Virginia appeals process. The new AIMS portal will handle the next level of appeal after members and providers have exhausted their appeal with Aetna Better Health. Visit the DMAS website to learn more about AIMS and access training resources. Or call DMAS Appeals at 804-371-8488.
April 22, 2021
The Department of Medical Assistance Services (DMAS) has released this bulletin (PDF) to alert providers of Addiction and Recovery Treatment Services (ARTS) and the following three Behavioral Health Services: Assertive Community Treatment (ACT), Mental Health Intensive Outpatient (MH-IOP), and Mental Health Partial Hospitalization (MH-PHP), that DBHDS will start processing Service Modifications on April 12, 2021.
New Policy Updates - Clinical Payment, Coding, and Policy Changes (PDF)
March 9, 2021
Expansion of Services with Optum (PDF)
The Aetna Better Health of Virginia Plan Portal is Getting an Upgrade (PDF)
January 8, 2021
We have updated our Fiscal Employer Agent (F/EA) Choice FAQ (PDF) based on recent changes to the member F/EA choice for consumer-directed services.January 4, 2021
A Note to Providers Regarding Check Run Schedule
There will be no check run on Monday, January 18, 2021, in observance of the Martin Luther King Jr. holiday. This has no impact to the Wednesday and Friday check run schedules for the holiday week.
2020
-
December 22, 2020
Virginia's COVID-19 vaccination priorities announced
Vaccine FAQS for Aetna Better Health members
Additional COVID-19 vaccination information from the Virginia Department of Health
December 11, 2020
DMAS Memo: Coverage of COVID-19 Vaccine Administration (PDF)
October 21, 2020
DMAS Memo: COVID-19 Flexibility Continuations Until 1/20/2021 (PDF)
June 26, 2020
Home and Community Based Services (HCBS) Waivers COVID-19 Policy Continuation and Timeline (PDF)
June 22, 2020
Emergency Payments for Medicaid Providers (PDF)
June 15, 2020
DMAS Notification: Emergency Payments for Medicaid Providers
March 27, 2020
What You Need to Know About the Coronavirus (COVID-19)
-
-
October 26, 2020
Below is the schedule for holiday check runs for claims. Please review these dates and contact Provider Relations with any questions.November: There will be no Wednesday check runs the week of Thanksgiving; all QNXT check runs will be executed on Friday, November 27, 2020. Paid dates will be executed on Tuesday, December 1, 2020. The routine Wednesday/Friday schedule will return the following week. The Monday check runs will not be impacted by the holiday schedule and will adhere to their normal schedule.
December: QNXT check runs will be executed on Wednesday, December 23, 2020. Paid dates will be Tuesday, December 29, 2020. The Monday, December 28, 2020, check runs will have a Wednesday December 30, 2020, paid date. These will be the final paid dates of 2020 in support of 1099 processing. There will be no check runs on Friday, December 25, 2020, due to the holiday.
January: All QNXT check runs will be executed on Wednesday December 30, 2020. Paid dates will be Tuesday, January 5, 2021. There will be no check runs on Friday, January 1, 2021, due to the holiday.
The routine check run schedule will return the following week. Reminders will be sent weekly through the end of the year.
August 31, 2020
Electronic Visit Verification (EVV) resources from DMAS
June 29, 2020
The Department of Medical Assistance Services (DMAS) has released a bulletin to notify hospitals and physicians about reimbursement changes for state fiscal year 2021 (PDF). These reimbursement changes apply to fee-for-service claims processed by DMAS and managed care claims processed by Aetna Better Health of Virginia. These policies are effective July 1, 2020.
June 5, 2020
In April 2020, due to the COVID-19 pandemic, Aetna Better Health of Virginia put recoupment and recovery efforts on hold. Starting on July 1, 2020, we will reestablish this process. Please email us if you have any questions or concerns.
June 3, 2020
We are updating our Claims system! Please be advised that our normal payments scheduled for June 26, 2020, will be made on June 25, 2020. In addition, due to the July 4th holiday, payments that are normally scheduled for July 3, 2020, will be made on July 2, 2020. Please email us if you have any questions or concerns.
March 19, 2020
Recently, Aetna Better Health of Virginia has received inquiries regarding the use of the JW modifier on Medicaid claims. Aetna Better Health follows state Medicaid guidance. The state has confirmed in their fee-for-service environment (FFS) that the JW modifier is not recognized. Providers should combine the charges for waste drugs with the charge for the administered drugs. Documentation must clearly identify the units billed for waste. If waste is billed on a separate line with the JW modifier, the FFS system will deny this code/modifier as a duplicate. Medicaid pricing guidance and payment will be based on the maximum allowable units per day.
Aetna Better Health follows these same guidelines. Billing for drug waste with a JW modifier is a Medicare requirement.
June 2020
Personal Care Providers: Notice Regarding Waiver Service Authorization (PDF)
April 2020
Personal, Respite and Companion Care Services Require Electronic Visit Verification (PDF)
March 2020
Our Appeals and Grievances Mailing Address Has Changed (PDF)
NPPES Provider Notification (PDF)
Provider Notification: Eviti Connect (PDF)
February 2020
2019
-
-
December 2019
Payment Integrity Program Update (PDF)
November 2019
EVV Provider Notification (PDF)
October 2019
Faxblast VA DSNP Change in Prior Authorization Number (PDF)
August 2019
Provider Notification: Upper Case Diagnosis Codes (PDF)
July 2019
Provider Notification: Span Billing (PDF)
TPL Data Processing Issue (PDF)
CMHRS Network Closure Notification (PDF)
June 2019
Personal and respite care services require Electronic Visit Verification (PDF)
Electronic Visit Verification resources from DMAS
Claim Edit Notification Respiratory Virus Panel (PDF)
May 2019
Do's and Don'ts of Colorectal Screening for Clinicians (PDF)
Prenatal Risk Assessment Form Provider Incentive Flyer (PDF)
MedPart B Provider Notice (PDF)