Winter

REQUIREMENTS: - Immediately: Billing and clinical teams must become familiar with doula service coverage and the Doula Care Recommendation Form submission process (email: AetnaBetterHealthVA-CaseManagement@Aetna.com or fax: 860-807-4933). Providers must understand that a physician recommendation is required before services begin. - Immediately: Pharmacy billing staff must review and bookmark the Pharmacy section of the Aetna Better Health Virginia provider website to access searchable formulary, PA criteria, and PA forms. Ensure staff use the CORRECT drug-specific PA form (e.g., "Atypical Antipsychotics Less Than 18yrs" for antipsychotics under 18; "Opioids" form for short/long-acting opioids excluding methadone) to reduce resubmissions and peer-to-peer reviews. - Immediately: Staff handling Home and Community-Based Services (CCC Plus Waiver) claims must update internal documentation procedures to ensure that when multiple individuals in the same household receive personal care from the same agency, each individual has a separate Plan of Care with individual ADL hours and properly documented shared IADL hours (meal prep, cleaning, laundry, shopping). If separate agencies are used, document that IADL hours are NOT shared. - By end of Q1 2025: Providers should complete the Provider Immunization Survey (aet.na/3AQ55X0) to help identify vaccination barriers and support resource development. - Ongoing: Ensure all providers have access to updated remittance reading guides and Member Benefits Quick Sheet available on the provider portal to support accurate billing and patient care coordination.