MedicaidDocumentationHigh impact
Cotiviti PCCV Implementation
Aetna Better Health of Virginia·VA·Provider Notification
Effective date
Jul 1, 2026
We identified it
Aug 13, 2026
Summary
Effective July 1, 2026, Aetna Better Health of Virginia is implementing Cotiviti Prepayment Clinical Chart Validation (PCCV) for inpatient Medicaid claims. This new process will temporarily deny claims to allow medical record review for clinical appropriateness and documentation validation, with claims reprocessed and recoded as needed per state guidelines.
Action Required
Before July 1, 2026: Billing team and inpatient facilities must prepare for Cotiviti PCCV implementation by (1) updating claim tracking workflows to account for temporary claim denials during PCCV review; (2) ensuring medical records are complete, accurate, and immediately retrievable when Cotiviti requests them; (3) establishing a process to respond to Cotiviti medical record requests at the address specified on request letters within required timeframes; (4) training billing and coding staff on the new recoding and reprocessing procedures; (5) notifying providers that claims will be temporarily denied and reprocessed—this is expected workflow, not a billing error. Establish expedited medical record retrieval procedures to minimize claim processing delays. Contact Aetna Better Health Provider Relations (1-800-279-1878) with implementation questions.