Announcements and News
Reminder: Aetna Better Health of Virginia acquired Coventry Health Care, Inc., (previously Southern Health) and MH Net. Therefore, if you are contracted with Coventry Health Care, Inc., Southern Health or MH Net, these are valid contracts for Aetna Better Health of Virginia participation. If you are holding one of these older contracts, please contact our Network Management team so we can update you to a current Aetna Better Health of Virginia contract document. Please email: NetworkDevelopment.firstname.lastname@example.org. The Medallion 4.0 transition of care period for Aetna Better Health of Virginia is 180 days from a member’s effective date. Authorization numbers are not needed from participating/non-participating providers billing non-pharmacy claims during a member's Medallion 4.0 transition of care period.
Important Announcements Regarding COVID-19
Please refer to this section for important provider announcements regarding Aetna Better Health of Virginia's response to COVID-19.
March 27, 2020
Provider Notification 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.
March 2020 - NPPES Provider Notification
March 2020 - Provider Notification: Eviti Connect
February 2020 - F/EA FAQ Document CDCN
February 2020 - Provider Notification: Services Facilitators
December 2019 - Payment Integrity Program Update
November 2019 - EVV Provider Notification
October 2019 - Faxblast VA DSNP Change in Prior Authorization Number
August 2019 - Network Relations Consultant contact list August 2019
August 2019 - Provider Notification: Upper Case Diagnosis Codes
August 2019 - 340B Drug Program
July 2019 - Duplicate Remit
July 2019 - Quick Reference Guide
July 2019 - Urine Drug Testing
July 2019 - Provider Notification: Span Billing
July 2019 - TPL Data Processing Issue
July 2019 - CMHRS Network Closure Notification
June 2019 - Claim Edit Notification Respiratory Virus Panel
May 2019 - MedPart B Provider Notice
May 2019 - Change in Prior Authorization Requirements
November 2018 - NRC Territory Assignments List
November 2018 - Check Run Information – Holiday End-of-Year 2018
September 2018 - Hurricane Florence State of Emergency
August 2018 - Medical Record Claims Review Reminder Notice
August 2018 - CMHRS Medallion 4.0 and CCC Plus Provider call
August 2018 - TOC Reminder
July 2018 - Change In Prior Authorization Requirements
July 2018 - Urine provider letter to Providers
October 2017 - Reimbursement Clarification for Tdap and Flu Vaccines
October 2017 - Reimbursement for Individuals Evacuated from a Disaster
October 2017 - Enhancements to LTSS ePAS Memo
October 2017 - GAP Update Memo
October 2017 - CCC Plus Pharmacy Transition Blast
October 2017 - Memo on Pharmacy
June 2017 - Peer Services Cover Memo
Archived Provider Notifications
Provider Notice 4/25/2018 - Aetna Better Health of Virginia has recently implemented systems changes to recognize and price claims at the appropriate Northern Virginia (NOVA) rate differentials. This system fix is effective April 18, 2018. Claims submitted after this date will recognize this rate differential. We are reviewing all claims submitted prior to this date for re-examination and reprocessing if necessary. Thank you for your continued patience and understanding with regard to this issue.
Provider Notice 4/11/2018 - The attached "CCC Plus Guidance Document" provides guidance on coordinating benefits with your members that are also covered under Medicare or a commercial carrier for CMHRS, ARTS, CCC Plus Waiver, and Early Intervention Services. The document also includes a Medicare and commercial by-pass list to show certain procedure codes that can be by-passed, not requiring review of TPL.
Provider Notice 3/30/2018 - Due to the length of our credentialing process, 90 to 120 days, and the volume of providers that are in the credentialing process, Aetna Better Health of Virginia (ABH VA) is voluntarily extending its transition of care/continuity of care period for CMHRS, and NF/SNF, providers to 5/31/18. This will provide time for ABH VA to successfully complete the credentialing for all CMHRS and NF/SNF providers that are currently in process. Thank you for your continued patience and for joining the ABH VA provider network.
Provider Notice 3/26/2018 - Aetna Better Health of Virginia continues its commitment to correct coding and the implementation of programs that support nationally recognized and accepted coding policies and practices. Evaluation and Management (E&M) coding is an area that the Centers for Medicare & Medicaid Services (CMS) has identified as having significant error rates. Starting with claims for dates of service on or after April 15, 2018, we will evaluate the appropriateness of E&M coding reported using CMS and AMA documentation guidelines for Office Visit codes: New Patients CPT codes 99201-99205, Established Patients CPT codes 99211-99215, and Office Consultations codes 99241-99245. Based on the outcome of this evaluation, your payment may be adjusted if the information submitted on the claim does not support the level of service billed. This payment adjustment will be noted with a #150 E&M explanation on your remittance advice report.
If you do not agree with a specific payment determination, you have the right to file a clinical editing dispute to this address: Aetna Better Health of Virginia, ATTN: Claims, PO Box 63518, Phoenix, AZ 85082-3518. As part of your dispute, you must submit the portion of the medical record that contains documentation to support the level of service you reported. We will review the submitted medical records to assess the intensity of service and complexity of medical decision-making for the E&M services reported. Aetna Better Health of Virginia may adjust those claims where documentation substantiates the provision of a higher level of E&M service. For additional details on the clinical editing dispute process, refer to the online Provider Services Handbook: https://www.aetnabetterhealth.com/virginia/
Aetna Better Health of Virginia will evaluate this program periodically based on billing trends and may make adjustments as necessary. If you have questions, please contact Provider Services at
Provider Notice 3/13/2018 - Home Health Providers - Billing Reminder - Aetna Better Health of Virginia is reminding home health providers that when billing revenue codes, the appropriate HCPC codes must be submitted. Starting Monday, 4/16/18, home health providers submitting claims that do not meet this billing format, will be rejected for correction and resubmission. If you have any questions regarding this issue please call 855-652-8249
Provider Notice 3/13/2018 - Aetna Better Health of Virginia encountered a system's issue with CMHRS codes in February that has impacted the submission of CMHRS claims. Code modifiers for H0032, H0035 and H0036, were accidentally overwritten during our quarterly update of DMAS rates. The H0032, H0035 and H0036 code modifiers have now been restored. Additionally, all historic claims submitted that were previously rejected, have been identified, and are being reprocessed. The ETA for reprocessing all previously rejected CMHRS H0032, H0035 and H0036 codes for modifier issues is the end of the 3rd full week of March.
We apologize for this technical issue and provider patience during claims reprocessing. If you have any questions regarding this issue please call 855-652-8249.
Provider Notice 2/27/2018 - Aetna Better Health of Virginia encountered a system’s issue with CMHRS codes recently that has impacted the submission of CMHRS claims to us. Code modifiers for H0032, H0035 and H0036, were accidentally overwritten during our quarterly update of DMAS rates. Consequently, claims for these codes may be been rejected in error by Aetna Better Health. We apologize for this issue, are working quickly to correct the technical issue, and will reprocess all historic claims associated with these claim codes. This information will be published on our secure Provider Portal. If you have any questions regarding this issue, please call 1-855-652-8249.
Provider Notice 06/16/2017 - There has been an amendment to the provider manual by the Department of Medical Assistance Services (DMAS). This amendment includes information for providers regarding Medicaid/FAMIS individuals who are enrolled in a managed care program. Click here to read the amendment.
Provider Notice 05/08/2017 - Attention Aetna Better Health of Virginia providers. Aetna’s operations in the individual and exchange market do not impact Medicaid/FAMIS. These are two different products. We are not leaving. We want to make sure you and our provider community know, we aren't going anywhere.
Provider Notice 03/28/2017 - Provider training opportunity for new ARTS program. Learn more, including how to register.
Effective 02/01/2017 - CVS Caremark Specialty will serve as our exclusive specialty provider for specialty medications. Please view our notice for more information.
Provider Notice 01/20/2017 - This is a reminder for providers attesting to meet ASAM levels 2.1 to 4.0. The deadline to submit is January 25. Learn more.
Provider Notice 12/14/2016 - You recently received a fax blast regarding prior authorizations for Circumcision services. Upon further review, we realized we were in error regarding CPT code 54150 (Circumcision for Newborns with clamp device) and have made the appropriate updates to the information in the letter that was sent via fax blast last month.
Effective 01/01/2017, Aetna Better Health of Virginia will require prior authorization for Circumcision services 54150, 54162, 54360 and 55180. The document has more information.
Provider Notice 12/09/2016 - This is a reminder for providers attesting to meet the ASAM levels 2.1 to 4.0. Please remember that the deadline for attestation is December 15, 2016. This form needs to be submitted to DMAS. Providers will need to demonstrate they meet ASAM criteria in order to be credentialed by the Medicaid MCOs and Magellan to participate in the DMAS Addiction and Recovery Treatment Services (ARTS) program which will be implemented April 1, 2017. The document has more information.
Effective 11/01/2016, eviCore is implementing a change of process for initiating Musculoskeletal pre-certification requests. The document has more information
Effective 10/25/2016, Aetna Better Health of Virginia members will require prior authorization for Cardiology services from eviCore healthcare for dates of service 11/01/2016 and after. The document has more information.
Effective July, 2016, Aetna Better Health of Virginia will be implementing MCG (Milliman Care Guidelines) Behavioral Health Guidelines (MCG BHG) as the primary medical necessity criteria for behavioral health. The document has more information.
On April 1, 2016, Aetna Better Health of Virginia entered into a partnership with eviCore healthcare to manage utilization of High-Tech Imaging, OB, and Non-OB Ultrasound studies. The document has more information.