What types of policy changes does Aetna Better Health of Virginia issue?

Aetna Better Health of Virginia regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Aetna Better Health of Virginia update its policies?

Aetna Better Health of Virginia typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

What should I do when Aetna Better Health of Virginia changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Aetna Better Health of Virginia Policy Changes & Prior Auth Updates

Q: How many Aetna Better Health of Virginia policy changes are tracked here?

This page currently tracks 21 documented Aetna Better Health of Virginia policy changes. New items are added as they are identified.

We track 21 documented policy changes from Aetna Better Health of Virginia across VA. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Aetna Better Health of Virginia notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Aetna Better Health of Virginia updates automatically.

High impact
New Policy Updates - Clinical Payment, Coding, and Policy Changes Effective October 1, 2025
Aetna Better Health of Virginia·Effective Oct 1, 2025
Aetna Better Health of Virginia is implementing five new clinical payment and coding policies effective October 1, 2025: (1) Multiple gestation diagnoses must include both complication and multiple gestation codes; (2) DME suppliers must have eligible referring/ordering NPIs; (3) NDC codes must match non-specific HCPCS drug codes; (4) Duplicate vaccine claims will be denied; (5) Infliximab for regional enteritis is limited to 5 administrations per 26 weeks. These policies will trigger claim denials if not followed.
High impact
Provider Notification - Residential Treatment Center Provider Billing and Encounter Issues
Aetna Better Health of Virginia·Effective Jul 8, 2025
Aetna Better Health of Virginia has implemented a front-end edit (effective July 8, 2025) that denies Residential Treatment Center claims billed with incorrect bill types. Providers must use the "specialty residential" bill type for these services. The plan will conduct a 365-day retrospective review and issue recoupment letters for incorrectly paid claims, allowing providers to rebill with corrected bill types within timely filing limits.
High impact
Provider Notification - Implementation of New Front-End Editing Tool and Error Code Updates
Aetna Better Health of Virginia·Effective Apr 1, 2025
Aetna Better Health of Virginia implemented a new front-end editing tool with SNIP-level validation that is rejecting claims with two new error codes. Error code 0x393967E requires descriptions for non-specific procedure codes (e.g., H0046), while error code 0x39395D7 prohibits descriptions for specific codes (e.g., 90651). Claims are currently receiving warnings instead of rejections, but rejections will resume on April 1, 2025.
High impact
UPDATED: Implementation of New Front-End Editing Tool and Error Code Updates
Aetna Better Health of Virginia·Effective Apr 1, 2025
Aetna Better Health of Virginia implemented a new front-end editing tool (SNIP validation) that is rejecting claims with 14 specific error codes related to missing or invalid data elements (dates, diagnoses, procedure descriptions, etc.). Currently, these errors are warnings until April 1, 2025, when they will convert to hard rejections. Billing teams must audit and correct all claims submitted since January 1, 2025, to avoid future denials.
High impact
Personal and respite care services require Electronic Visit Verification
Aetna Better Health of Virginia·Identified Aug 13, 2026
Aetna Better Health of Virginia now requires Electronic Visit Verification (EVV) for all personal and respite care services. This is a new administrative requirement that affects how these services are documented and verified for Medicaid beneficiaries in Virginia.
High impact
Personal, Respite and Companion Care Services Require Electronic Visit Verification
Aetna Better Health of Virginia·Identified Aug 13, 2026
Aetna Better Health of Virginia now requires Electronic Visit Verification (EVV) for Personal, Respite, and Companion Care Services. Billing teams must ensure all claims for these services include EVV documentation or face claim denials. This is a new documentation and compliance requirement for Medicaid managed care services in Virginia.
High impact
Fax Blast - Policy Changes to Mental Health-Partial Hospitalization Program (MH-PHP) H0035 Provider Requirements
Aetna Better Health of Virginia·Identified Aug 13, 2026
Aetna Better Health of Virginia has issued a policy update regarding Mental Health-Partial Hospitalization Program (MH-PHP) provider requirements for billing code H0035. The specific changes to provider requirements cannot be fully assessed as only a summary was provided rather than the complete policy document.
High impact
Provider Reminder - CLIA Certificate Editing
Aetna Better Health of Virginia·Identified Aug 13, 2026
Aetna Better Health of Virginia is reminding providers that laboratory claims must include valid and active CLIA certificate numbers in the correct claim submission locations to avoid denials. Providers receiving CARC/RARC 16/MA120 denials must verify CLIA numbers are properly submitted: on electronic claims in Loop 2300 (REF01=X4, REF02) or on paper CMS 1500 forms in Field 23, with hyphens or semicolons separating multiple items.
High impact
Best Practices for Verifying Coverage and Prior Authorization Requirements for Services
Aetna Better Health of Virginia·Identified Aug 13, 2026
Aetna Better Health of Virginia has issued best practice guidelines to reduce prior authorization and non-covered service claim denials. The policy establishes a three-step verification process: (1) verify member eligibility and coverage, (2) use ProPat tool to check prior authorization requirements, and (3) confirm the service is covered per DMAS Fee Schedule, with special attention to flag code 999 (non-covered) and IC codes (individual consideration).
High impact
Provider Notification - New Front-End Claim Edits - Provider Specialty & Type
Aetna Better Health of Virginia·Identified Aug 13, 2026
Aetna Better Health of Virginia has implemented new front-end claim edits that validate provider specialty and provider type information at the point of claim submission. Claims that do not match the enrollee's provider specialty and type requirements will be subject to these edits, potentially affecting claim processing and reimbursement.
High impact
Coming Soon: Use Eviti Connect™ to Submit Requests for All Cancer Types and Imaging
Aetna Better Health of Virginia·Identified Aug 13, 2026
Aetna Better Health of Virginia is implementing Eviti Connect™ as the required submission platform for all cancer type prior authorization requests and imaging requests. This represents a shift in the authorization workflow for oncology and imaging services in Virginia's Medicaid program.
Medium impact
Provider Notification - Criminal Background Screening Policy
Aetna Better Health of Virginia·Effective May 1, 2025
Aetna has implemented a new criminal background screening policy requiring all Aetna providers to conduct criminal background checks on employees before hire and every three years thereafter. Providers must maintain documentation, disclose the process to employees, provide records to Aetna annually, and comply with annual audits. This is an operational/compliance requirement, not a clinical or billing code change.
Medium impact
Provider Notification - Claims Payments
Aetna Better Health of Virginia·Identified Aug 13, 2026
Aetna Better Health of Virginia has engaged a vendor to identify and pursue third-party liability payers for Medicaid members, then conduct reclamation billing. Providers may be asked to submit documentation, and when recovery occurs, providers will see offsetting credit and debit entries on remit statements that net to zero—meaning no additional payment impact but requiring careful reconciliation of claim adjustments.
Medium impact
Provider Reminder - CLIA Certificate Editing
Aetna Better Health of Virginia·Identified Aug 13, 2026
Aetna Better Health of Virginia is reminding providers that laboratory claims must include valid and active CLIA certificate numbers to demonstrate compliance with federal laboratory testing requirements. Providers must submit CLIA numbers on all laboratory claims using the correct format: Loop 2300 REF01=X4 for electronic claims or Field 23 on CMS 1500 paper claims, with multiple items separated by hyphens or semicolons.
Medium impact
Fall
Aetna Better Health of Virginia·Identified Aug 13, 2026
Aetna Better Health of Virginia's Fall 2024 provider newsletter communicates updates on language services, the KED HEDIS measure for diabetic kidney health evaluation, formulary requirements, utilization management criteria hierarchy, social determinants of health (SDOH) coding, and home and community-based services delivery. Key billing impacts include mandatory documentation of SDOH using ICD-10 Z codes (Z55-Z65) and adherence to updated UM/prior authorization criteria hierarchy.
Medium impact
Winter
Aetna Better Health of Virginia·Identified Aug 13, 2026
This Winter 2024 provider newsletter from Aetna Better Health of Virginia highlights several updates for Medicaid providers, including newly covered doula services (requiring PCP/OB-GYN recommendation and specific form submission), pharmacy prior authorization process improvements with drug-specific PA forms, and clarified guidance on personal care services billing for multiple individuals in the same household under the CCC Plus Waiver. Key updates include doula service requirements, proper PA form selection to reduce claim denials, and shared IADL hour documentation for household-based care.
Medium impact
Provider Notification - Resubmission through Availity
Aetna Better Health of Virginia·Identified Aug 13, 2026
Aetna Better Health of Virginia has established a new procedural requirement for providers to submit claim resubmissions, attachments, and reconsiderations through the Availity Provider Portal using the 'Send Attachments' function under Claim Status—not through the Appeals section. This applies to itemized bills, duplicate claims, proof of timely filing, coordination of benefits, claim/coding edits, and corrected claims for Aetna Better Health plans and NJ-VA MAPD/DSNP plans.
Medium impact
Developmental Screening in the First Three Years of Life (DEV)
Aetna Better Health of Virginia·Identified Aug 13, 2026
Aetna Better Health of Virginia has issued a new HEDIS quality measure policy requiring developmental screening for children ages 1-3 using standardized tools at specific ages (9, 18, and 30 months), with autism-specific screening at 18 and 24 months. Billing teams must ensure CPT 96110 is captured when providers perform these screenings using approved standardized instruments to meet this quality metric for measurement year 2025.
Low impact
Provider Notification - Enhancing Claim Submission Capabilities Through Availity
Aetna Better Health of Virginia·Effective Jun 16, 2025
Aetna Better Health of Virginia is expanding claim submission options through Availity, effective no sooner than June 16, 2025. Providers will gain the ability to submit claims via direct data entry and batch submissions through the Availity Clearinghouse, while existing submission channels remain available. This is an optional enhancement that does not require switching from current submission methods.
Low impact
National Suicide Prevention Lifeline - Use “988” for Mental Health Support
Aetna Better Health of Virginia·Identified Aug 13, 2026
Aetna Better Health of Virginia is notifying providers about the National Suicide Prevention Lifeline's transition to the 988 call number for mental health support. Providers should communicate this resource to patients and update any patient-facing materials, websites, or referral documentation that may reference older crisis hotline numbers.
Low impact
Spring
Aetna Better Health of Virginia·Identified Aug 13, 2026
This Aetna Better Health of Virginia provider newsletter (Spring 2024) contains administrative guidance updates including expanded use of the Availity provider portal, new continuing education modules, clarification on interpreter services as a covered benefit, and emphasis on integrated care management and inter-provider communication. No new billing code changes or coverage restrictions are imposed, but practices should ensure compliance with communication and care coordination expectations.

Aetna Better Health of Virginia in VA Aetna Better Health of Virginia: Allergy & Immunology Aetna Better Health of Virginia: Audiology Aetna Better Health of Virginia: Critical Care Aetna Better Health of Virginia: Dentistry All payers

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New Policy Updates - Clinical Payment, Coding, and Policy Changes Effective October 1, 2025

Provider Notification - Residential Treatment Center Provider Billing and Encounter Issues

Provider Notification - Implementation of New Front-End Editing Tool and Error Code Updates

UPDATED: Implementation of New Front-End Editing Tool and Error Code Updates

Personal and respite care services require Electronic Visit Verification

Personal, Respite and Companion Care Services Require Electronic Visit Verification

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

Provider Reminder - CLIA Certificate Editing

Best Practices for Verifying Coverage and Prior Authorization Requirements for Services

Provider Notification - New Front-End Claim Edits - Provider Specialty & Type

Coming Soon: Use Eviti Connect™ to Submit Requests for All Cancer Types and Imaging

Provider Notification - Criminal Background Screening Policy

Provider Notification - Claims Payments

Provider Reminder - CLIA Certificate Editing

Fall

Winter

Provider Notification - Resubmission through Availity

Developmental Screening in the First Three Years of Life (DEV)

Provider Notification - Enhancing Claim Submission Capabilities Through Availity

National Suicide Prevention Lifeline - Use “988” for Mental Health Support

Spring