MedicaidBilling CodesHigh impact
Provider Notification - Residential Treatment Center Provider Billing and Encounter Issues
Aetna Better Health of Virginia·VA · Psychiatry, Critical Care·Reimbursement
Effective date
Jul 8, 2025
We identified it
Aug 13, 2026
Summary
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.
Action Required
Immediately: Billing team must audit all Residential Treatment Center claims submitted to Aetna Better Health of Virginia to identify those using incorrect bill types. By the retrospective review completion: Review any recoupment letters received from Aetna and identify claims marked with CARC 282 (Procedure/Revenue Code Inconsistent with Type of Bill) or RARC MA30 (Missing/incomplete/invalid type of bill). Update billing software and claim submission processes to require the "specialty residential" bill type for all Addiction Recovery Treatment Services and Residential Treatment Services claims submitted to this plan. When resubmitting corrected claims, ensure the corrected claim identifier/claim frequency code is included per plan requirements. Providers must resubmit within timely filing deadlines. Failure to correct billing practices will result in continued claim denials through the implemented front-end edit.