MedicaidPrior AuthHigh impact
Provider Notification - New Timeline for Prior Authorizations
Aetna Better Health of Virginia·VA·Provider Notification
Effective date
Jan 1, 2026
We identified it
Aug 13, 2026
Summary
Effective January 1, 2026, Aetna Better Health of Virginia must issue prior authorization decisions within seven calendar days for standard (non-urgent) requests, per CMS mandate. Billing teams must ensure all clinical documentation is included with prior auth requests to avoid delays or denials.
Action Required
By December 31, 2025: Billing team must implement workflow changes to ensure all prior authorization requests submitted to Aetna Better Health of Virginia include complete clinical documentation upfront. Update internal prior auth submission checklist and provider instructions to emphasize documentation requirements. Train front desk staff and billing personnel on the new seven-day decision timeline. Monitor for compliance and track Aetna's adherence to the new timeline. Communicate with providers that incomplete requests may result in delays or adverse decisions. Update billing system workflows to flag Aetna Better Health of Virginia prior auth requests for expedited processing given the compressed timeline.