[Virginia] Authorization required for sick newborn DRG payment

Effective immediately for Virginia Medicaid claims: (1) Billing team must update claim submission workflow to verify sick newborn authorization is on file BEFORE submitting any claim with sick newborn DRG assignment. (2) Establish internal process requiring providers to request sick newborn authorization from HealthKeepers utilization management with supporting clinical documentation prior to billing. (3) Update encounter forms and EMR templates to prompt providers to document newborn clinical status and ensure DRG assignment aligns with medical record. (4) Include authorization number on all sick newborn DRG claims submitted to HealthKeepers. (5) Train billing staff and providers that claims lacking authorization will be downgraded to well newborn DRG rates, resulting in lower reimbursement. Submit authorization requests to HealthKeepers UM via Availity Chat with Payer (https://Availity.com) during business hours.