Skip to main content

Notices and newsletters

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

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 email us. Be sure to specify your question in the email subject line (ex: COVID-19 claims, COVID-19 appeals, etc.).

 

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)

Also of interest: