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Notices and newsletters

Stay up to date on the latest provider news and helpful information.

2024

June 11, 2024

 

Deletion of the Vision Manual

 

Updates to the Procedures for Service Authorization Appendix (Appendix C) of the Residential Treatment Services Manual

 

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 Manual

 

Fee 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

 

Updates and Information on Fee-For-Service Behavioral Health Services Post Transition of Behavioral Health Services Administration

 

March 14, 2024

 

Deletion of Podiatry Manual

 

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

 

New Medicare Coverage: Outpatient Psychiatric and ASAM 1.0 Services and Intensive Outpatient Services (Mental Health and ASAM 2.1) 

 

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

 

Virginia Medicaid Preferred Drug List / Common Core Formulary Changes, 90 Day Supply List Changes, and Drug Utilization Review Board Approved Drug Service Authorizations

 

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

 

12-Month Continuous Eligibility (CE) for Children – Implementation of Mandated Provision of the Consolidated Appropriations Act of 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

 

Annual Service Plan Contractor for Fee-For-Service Individuals on the CCC Plus Waiver Effective 1/1/2024

 

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

 

National Provider Identifier (NPI) Requirement on Health Department Clinic Claims for Enteral Formula

 

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

 

Mobile Crisis Response (H2011) process changes effective December 15, 2023 per Department of Behavioral Health and Developmental Disabilities (DBHDS) Administrative Instructional Memo

 

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

 

Update on Changes for Long Term Services and Supports and Hospice Services Under Cardinal Care Managed Care (CCMC)

 

General Update on Cardinal Care - Virginia’s Medicaid Program, Including Changes Under Cardinal Care Managed Care (CCMC)

 

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

 

Provider Training on How to Register and Submit Successful Service Authorization Requests to Acentra Health (Formerly Known as Kepro) Effective November 1, 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

 

Updates to the Comprehensive Crisis and Transition Services - Appendix (Appendix G) of the Mental Health Services Manual (PDF)

 

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

 

Update to Addiction and Recovery Treatment Services (ARTS) Manual Chapters 2, 4, and 6, and Preferred Office-Based Addiction Treatment and Opioid Treatment Program (OBAT-OTP) Supplement

 

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

 

Psychiatric Residential Treatment Facility (PRTFs), Addiction and Recovery Treatment Services (ARTS) Residential Services Rate Changes Effective July 1, 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

 

Virginia Medicaid Preferred Drug List / Common Core Formulary Changes, 90 Day Supply List Changes, FDA Approval of Over-the-Counter Naloxone, and Drug Utilization Review Board Approved Drug Service Authorizations

 

July 5, 2023

 

Medicaid Home Health Care Services (HHCS) Provider Manual update to include Electronic Visit Verification (EVV)

 

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

 

Behavioral Health Services Administrator (BHSA) Changes Due to Magellan Contract Ending – Electronic Funds Transfer Update Required for Providers Currently Enrolled with the Magellan of Virginia BHSA

 

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

 

Reimbursement for COVID services under Emergency Medicaid after the end of the federal Public Health Emergency (PDF)

 

April 20, 2023

 

No Requirement for Exclusive Telemedicine Providers to Maintain a Physical Presence in Virginia

 

Telehealth Updates to Outpatient Psychiatric and Addiction Recovery and Treatment Services (ARTS) Services

 

April 17, 2023

 

Updated coverage of Pfizer-BioNTech bivalent COVID-19 vaccine booster doses for select children 6 months through 4 years of age

 

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

 

Hospital Providers to Submit Requests for Non-Resident Alien Emergency Inpatient Admissions to Kepro for Service Authorization: Effective March 13, 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

 

Updated Coverage of Moderna and Pfizer-BioNTech Bivalent COVID-19 Booster Doses, Coverage of Novavax COVID-19 Booster Doses and CLIA Requirements for Select COVID-19 Testing

 

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

 

Updates to Comprehensive Crisis and Transition Services (Appendix G) of the Mental Health Services Manual

 

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 Medicaid

 

November 1, 2022

 

Updates to the Home and Community Based Services (HCBS) Developmental Disability Waivers Manual

 

October 5, 2022

 

Coverage of Moderna and Pfizer-BioNTech bivalent COVID-19 boosters and expanded coverage of Novavax COVID-19 vaccine

 

July 27, 2022


Coverage of Pfizer and Moderna COVID-19 Vaccines For Children and Novavax COVID-19 Vaccine for Adults

 

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.

Learn more here.

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

 

12 Months Postpartum Continuous Coverage; Removal of Co-Payments; Behavioral Health Services; Technical Updates to Emergency Services and Appeals Sections

 

November 22, 2022

 

Virginia Medicaid Preferred Drug List / Common Core Formulary Changes, and New Drug Utilization Review Board Approved Drug Service Authorizations

 

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

 

Updates to the Private Duty Nursing Chapter of the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Supplement

 

October 4, 2022

 

Hospital & Ambulatory Surgical Centers (ASCs) 3M Grouper Updates (Effective July 1, 2022)

 

New Automated Claims Processing for Emergency Medical Certifications (EMC) for Undocumented Individuals

 

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

 

Updates to Comprehensive Crisis Services (Appendix G) of the Mental Health Services Manual (Effective September 1, 2022)

 

August 5, 2022

 

Developmental Disabilities Waiver Services and Home and Community Based Services Rate Updates (Effective July 1, 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

 

Psychiatric Residential Treatment Facility, Addiction and Rehabilitation Treatment Services, Peer Recovery and Family Support Services Rate Changes Effective July 1, 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

 

Virginia Medicaid Preferred Drug List / Common Core Formulary Changes, 90 Day Supply List Changes, and Drug Utilization Review Board Approved Drug Service Authorizations

 

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

 

Medicaid Long Term Services and Supports Screening in Nursing Facilities, Screening Restoration after COVID-19 Flexibilities

 

April 26, 2022

 

Medicaid Pre-Pay Diagnosis-Related Grouping Review (PDF)

 

Medicaid Pre-Pay Diagnosis-Related Grouping Review Program FAQ (PDF)

 

April 14, 2022

 

Fax Blast - Policy Changes to Mental Health-Partial Hospitalization Program (MH-PHP) H0035 Provider Requirements

 

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.

 

Learn more about HEDIS

 

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

 

DMAS Transition from VAMMIS To Medicaid Enterprise System (MES) Reminders and Frequently Asked Questions Answered

 

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

 

Preparations to Resume Normal Eligibility and Enrollment Operations: Member Toolkit and Resource Information

 

DMAS Transition from VAMMIS To Medicaid Enterprise System (MES): Key Functions for Fee for Service Providers

 

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

 

New Implementation Client

 

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

 

Update on Claims Reprocessing for Temporary Home and Community Based Services (HCBS) Rate Update, Effective July 1, 2021

 

January 1, 2022

 

Consumer Directed and Agency Directed Personal Care, Respite Care, and Companion Care Update Effective January 1, 2022

 

Inter-Rater Reliability Study of LTSS Screenings

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)

 

Developmental Disabilities (DD) and Commonwealth Coordinated Care (CCC) Plus Waivers: Provider Flexibilities Related to COVID-19 (PDF)

 

March 2, 2021

 

Enhanced Behavioral Health Services / Project BRAVO: Behavioral Health Redesign for Access, Value & Outcomes (PDF)

 

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

 

Update Developmental Disabilities (DD) and Commonwealth Coordinated Care (CCC) Plus Waivers: Provider Flexibilities Related to COVID-19 (PDF)

 

COVID-19 Flexibility Continuations Until 4/20/2021 (PDF)

 

January 11, 2021

 

Implementation of Medicaid Long Term Services and Supports (LTSS) Screening Conducted by Nursing Facilities (PDF)

 

January 7, 2021

 

Electronic Visit Verification Live-In Caregiver Exemption and Consumer-Directed Personal Care Overtime (PDF)

 

January 5, 2021

 

Pharmacy Procedure For COVID-19 Vaccine (PDF)

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

 

Behavioral Health Expansion (BHE): New Behavioral Health Services for Virginia’s Medicaid Members (PDF)

 

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

 

HCBS Rate Increase FAQ (PDF)

 

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

 

RC Claim Assist (PDF)

 

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

 

DMAS Memo: Dental Coverage for Medicaid Enrolled Adults (21 years of age and older) - Effective July 1, 2021 (PDF)

 

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

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

 

Provider Notification: Services Facilitators (PDF)

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