MedicaidAdministrativeHigh impact
Provider Notification - New Front-End Claim Edits - Provider Specialty & Type
Aetna Better Health of Virginia·VA · Psychiatry, Occupational Medicine, Occupational Therapy +1 more·Reimbursement
We identified it
Aug 13, 2026
Summary
Aetna Better Health of Virginia is implementing new front-end claim edits for behavioral health, crisis, and substance use services that will deny claims if the billing provider is not enrolled with the correct provider specialty and type. Billing teams must validate provider enrollment, confirm correct taxonomy codes, and ensure internal systems are updated to prevent automatic claim denials for ARTS, crisis stabilization, and care coordination services.
Action Required
IMMEDIATELY: Billing team must (1) Validate provider enrollment in DMAS MES portal to confirm correct provider specialty and type designations for all providers billing ARTS-Opioid Treatment Services (individual and group), Substance Use Care Coordination, Assertive Community Treatment, 23-Hour Crisis Stabilization, Residential Crisis Stabilization Unit, Mobile Crisis, Community Stabilization, and Multisystemic Therapy services; (2) Confirm all claims are submitted with correct taxonomy codes and applicable modifiers; (3) Review and update internal billing systems and clearinghouse configurations to reflect correct provider type/specialty alignment; (4) Submit any needed Specialty Additions or Update requests through DMAS provider portal using fillable PDF forms sent to VAMedicaidProviderEnrollment@gainwelltechnologies.com. Failure to complete these actions will result in front-end claim denials requiring correction and resubmission. Policy was deployed 'soon' per notification dated 3 days ago—effective date not explicitly stated but treat as imminent.