Provider Notification - Medicaid Precertification Optimization - Code Removals

By February 5, 2024: Billing team must immediately update the billing system to REMOVE prior authorization requirements for all 58 listed codes when billing Aetna Better Health of Virginia Medicaid plans. Specifically: (1) Remove these codes from any prior auth hold lists or workflows in the billing software; (2) Update encounter templates and provider order entry systems to eliminate authorization request triggers for these codes; (3) Communicate the change to all clinical staff and providers to prevent unnecessary authorization requests; (4) For any pending claims submitted before February 5 that were held pending authorization for these codes, resubmit without prior auth requirement. Failure to update these workflows will result in unnecessary claim delays and administrative burden, though claims should ultimately process without prior auth. Contact Aetna Better Health of Virginia Provider Relations at 1-800-279-1878 (TTY: 711, M-F 8 AM-6 PM) with questions.