Materials and Forms for Providers | Aetna Medicaid Virginia

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Provider materials and forms

Materials

Provider manual (PDF)

Provider Manual Regulatory Compliance Addendum (PDF)

Provider quick reference guide (PDF)

COVID-19 Billing Reference Guide - Updated May 27, 2021 (PDF)

Remit – How to Read (PDF)

Forms

Electronic remittance advice (ERA) enrollment/change/cancellation form (PDF)

Electronic funds transfer (EFT) enrollment/change/cancellation form (PDF)

Provider dispute and resubmission form (PDF)

Behavioral health/community mental health rehabilitation services (CMHRS) expansion forms

Critical incident report form (PDF)

Managed care organization (MCO) authorization processes form (PDF)

Prior Authorization Request Form (PDF)

Addiction and recovery treatment services (ARTS) authorization and registration forms

Community Mental Health Rehabilitative Services (CMHRS) and BRAVO authorization and registration forms

Prenatal risk assessment form (PDF)

Provider notification: Eviti Connect for oncology patients (PDF)

Member materials and forms

Find all the forms a member might need — right in one place.

Materials and forms