MedicaidAdministrativeHigh impact
Provider Registration Requirements Reminder
Aetna Better Health of Virginia·VA·Network
We identified it
Aug 13, 2026
Summary
Aetna Better Health of Virginia is reminding all providers that active Medicaid enrollment verification through the state's PRSS portal is mandatory before rendering services to Medicaid members. Claims will be rejected or denied if the billing, rendering, attending, referring, supervising, prescribing, or operating provider does not have an active Medicaid ID on the state's provider enrollment registry. All providers must ensure their NPI, taxonomy code, practice address, billing address, and practice type match their MES registration to avoid claim denials.
Action Required
IMMEDIATE ACTION REQUIRED: (1) Billing team must verify that ALL providers submitting claims (billing, rendering, attending, referring, supervising, prescribing/ordering, and operating providers) have active enrollment in the Virginia Medicaid Enterprise System (MES) via the PRSS portal at virginia.hppcloud.com before submitting any claims. (2) Audit all claim submission workflows to ensure NPI, taxonomy code, practice address (with ZIP+4), billing address (with ZIP+4), and practice type on every claim exactly match the information registered in the Virginia Medicaid MES system. (3) Update billing software/claim submission rules to validate provider enrollment status before claim submission. (4) Providers must register at www.dmas.virginia.gov/for-providers/provider-enrollment-revalidation or virginia.hppcloud.com using the PRSS portal. (5) All rendering providers must include taxonomy codes on claims (EDI Loop 2000A-PRV or 2310B-PRV for institutional; Box 24J or Box 33B for CMS-1500; Box 81 with B3 qualifier for UB-04). CONSEQUENCE: Claims will be automatically rejected (EDI) or denied (paper) if any provider on the claim lacks an effective Medicaid ID in the state registry. No balance billing is permitted; providers are responsible for resolving state registration issues.