Aetna better health of virginia ccc plus prior authorization form
Aetna better health of virginia ccc plus prior authorization form. If you received more than a 34-day supply with Aetna Better Health® of Virginia, you don’t need to meet the two-fill requirement. Providers, get materials and forms such as the provider manual and commonly used forms. When you request prior authorization for a member, we’ll review it and get back to you according to the following timeframes: Routine – 14 calendar days Why keep current? Connect with members. CCC Plus members: October 1, 2021 – Dec 31, 2021. Rides. LTSS. A current list of the services that require authorization is available on ProPAT, our online prior authorization search tool. Aetna; Anthem; Molina; Optima; United Healthcare; Virginia Premier below. You can also find out where to get the COVID-19 vaccine. Drug Name (please circle) As the COVID-19 situation changes, we want to make sure you get the care you need, when you need it. Fax back to 1-855-799-2553 . These policies are effective July 1, 2020. What’s. 0/FAMIS: 1-800-279-1878, press * then option 1 CCC Plus: 1-855-652-8249, press * then option 1 For Addiction Recovery Treatment Services (ARTS) forms, visit our Materials and Forms page on our Here’s how to do it: Download the MAC submission form (PDF). If you have a member who needs one or more of these services, please contact Member Services at 1‑866‑600-2139 for more information. completed prior authorization request form to 855-799-2553 or submit Electronic Prior Authorization through CoverMyMeds® or SureScripts. CCC Plus Medicaid Expansion members: November 1, 2021 – December 31, 2021. AVAPEC-1619-17 July 2018. You can call Monday through Friday, 8 AM to 7 PM and Saturday, 9 AM to 12 PM. Cardinal Care Member Handbook — English (PDF) | Spanish (PDF) | Arabic (PDF) | Vietnamese (PDF) Diabetes wellness exam flyer ― English (PDF) | Spanish (PDF) Transitioning from Pediatrics to Primary Care Flyer ― English (PDF) | Spanish (PDF) (Form continued on next page. Our Provider Portal Instructions can help get you started. to 6:00 p. PA is not needed for emergency care. If you are a member in one of the Aetna Medicare Advantage Dual Eligible Special Needs Plan, we may help coordinate your Medicare and Medicaid covered services for you. Provider Manual Aetna Better Health ® of Virginia Last reviewed/revised: March 2020 For contract year July 1, 2020 - June 30, 2021 Sep 30, 2021 · Your Aetna formulary is below. (Interpretation services available). Please include the following: conservative treatment tried without success, applicable diagnostic testing with results, lab values and a medication list. 24-Hour Nurse Line and telehealth. Rheumatoid arthritis. Tell them you choose Aetna Better Health of Virginia as your plan. Universal-Pharmacy-Prior-Authorization-Request-Form-VA. On October 1, 2023. Aetna Better Health of Michigan. Drug Name (please circle) Fill out this form to find providers and health care services near you. $25 Wellness exam (to include HbA1c labs and LDL-C screening) $15 Woman’s mammography. If your practice already uses Availity, simply contact your administrator to request a username. You can fax your authorization request to 1-855-734-9389. You can fax all LTSS authorization requests to 1-844-459-6680 . Set up Availity account. Any cumulative opioid prescription exceeding 90 morphine milligram equivalents (MME) per day. Extended release buprenorphine (SublocadeTM) PA Criteria Align with Virginia Board of Medicine’s Regulations Governing Prescribing of Opioids and Buprenorphine Fax back to 1-855-799-2553. 0 Nuplazid (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Learn more about our special programs to help you get the care you need. Incomplete requests will delay the prior authorization process. For provider use only, have Medicaid Provider ID Number available. Behavioral health crisis line: 24 hours a day, 7 days a week. 0 REQUEST FORM METHADONE Fax back to 1-855-799-2553 If the following information is not complete, correct, or legible, the PA process can be delayed. An Authorized Representative is a person Pharmacy Prior Authorization Fax numbers: 1- 855-799-2553. Complete the form, then hit the “submit” button. www. On this page, you can learn more about the virus, including tips to help you stay as healthy as possible. If the following information is not complete, correct, or legible, the PA process can be delayed. $25 Prostate cancer screening After your exam, just have your doctor complete the wellness rewards form below and fax it to us at prior authorization via our Online Prior Authorization Search Tool. Avoid claims payment delays when we have all your correct info on file. Telling Aetna Better Health if member has other health insurance, including Medicare. You're about to leave Aetna Better Health of Virginia. $15 Flu shot. When conditions are met, we w ill authorize the coverage of Steroids Non-Preferred (Medicaid). We’re here for you Monday through Friday, 8 AM to 6 PM. 0 Previous Effective Date: 08/1/17 (02/1/17 PDL criteria), 12/1/17, 2/1/18, 3/1/18, 6/1/18, 7/1/18, 8/1/18, 10/1/2018, 12/1/2018, 2/4/19, 3/1/19, 4/1/19, 5/1/2019, 6/3/2019, All MCOs rely on Contract Standards for the CCC Plus Contract, 3 business days or up to 5 business days if additional information is required and 14 days for the Medallion 4. Call to learn more about Aetna Better Health® of Virginia and how to get all covered services. The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. Members ages 18 years or older can schedule a ride. You can get help 24 hours a day, 7 days a week. To: All Providers Participating in the Virginia Medicaid and FAMIS Programs. By phone: Call Cover Virginia at 1-833-5CALLVA (TDD: 1-888-221-1590). Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Help stopping nicotine use. completed prior authorization request form to 855-799-2553 or submit Electronic Prior Authorization CoverMyMeds® or SureScripts. aetnabetterhealth. Members in managed care can keep their health plan and do not need to take any action to enroll in Cardinal Care Managed Care. As a member, you’ll enjoy benefits and services that can help you reach your health goals. In person: Visit your local Department of Social Services. Services must be completed by December 31, 2021. You’ll want to get PA for these medications. O. Medicare-Medicaid plan materials. prior authorization via our Online Prior Authorization Search Tool. Member materials. Get paid faster. Dec 6, 2023 · Effective January 1, 2024, Acentra Health (formerly KePRO), the FFS service authorization contractor, will conduct annual level of care reviews and develop the annual service plan, using a modified version of the DMAS-99, for FFS members enrolled in the CCC Plus Waiver. Aetna Better Health ® of Maryland requires PA for some outpatient care as well as for planned hospital admissions. Drug Name To assist with translation services needs for multiple languages (including ASL) on various formats, including in-person, telephonic, and by video (Zoom), you or the member can call our Interpreter Services line at 1-800-385-4104 (TTY: 711). PO Box 81040. Incomplete forms or forms without the chart notes will be returned. Know the benefits that are available to you. When conditions are met, we will authorize the coverage of Enstilar (Medicaid). 652 -8249 (866) 669 Telling Aetna Better Health and DMAS when member’s address changes. If you don’t know who your administrator is, call Availity at 1-800-282-4548 for help. Aetna Better Health members will receive assistance, if required, to file either a Grievanceor an Appeal. Jun 23, 2023 · DMAS will soon be issuing a memo (link here) to notify providers about changes to the Preferred Drug List (PDL). The form will open your email with the form attached. 0 at 1-855-799-2553. Please use one form per member. CCC Plus members can get long-term services and supports (LTSS) through Medicaid managed care plans like Aetna Better Health® of Virginia. Last Name: First Name: Medicaid ID Number: Date of Birth: – Aetna Better Health® of Virginia CCC Plus and Medallion/FAMIS 4. CCC Plus has the same Health Plans. You can call us with your grievance or appeal at 1-800-279-1878 (TTY: 711). Here’s how to get in touch with our UM team: Call 1-888-348-2922 (TTY: 711), Monday through Friday, 8:30 AM to 5 PM, to reach the UM department. 0 REQUEST FORM ORAL BUPRENORPHINE PRODUCTS Fax back to: 1-855-799-2553 Oral Buprenorphine Products Do not require a PA if: • It is for a preferred product Suboxone® SL film or buprenorphine/naloxone tablets; • If the member is 16 Fax signed forms to Aetna Better Health Virginia CCC Plus and Medallion/FAMIS 4. Botulinum-Toxins-Request-Form-VA. Remember to ask for a ride at least three business days before you need it. Please note t hat all authorization requests will be reviewed as the AB rated generic (when available) unless states otherwise. Or schedule your ride online. VA-20-03-24 . Please note that all authorization requests will be reviewed as the AB rated generic (when available) unless states otherwise . m. Get your vaccine. Aetna Better Health of Prior authorizations Call 1-800-279-1878. Monthly monitoring may be in the form of telehealth visits including phone calls. Fax the PA form to 1-855-799-2553 Or you can call us to ask for PA. Medicaid materials and forms. Jan 1, 2021 · Aetna Better Health® of Virginia CCC Plus and Medallion/FAMIS 4. Prior Authorization (PA) Form. -5:00 p. We’ll return your call. Help our members find you and connect with you for the care they need. Your new Medicaid 2 health coverage offers many benefits and services. 0 REQUEST FORM FOR STIMULANTS/ADHD MEDICATIONS FOR CHILDREN LESS THAN FDA INDICATED AGE AND ADULTS OVER 18 . Provider data info. If your practice is new to Availity, you can use the registration link below to set up your account. 0: 1-800-279-1878 CCC Plus: 1-855-652-8249 Aetna Medicare Advantage Dual Eligible Special Needs Plans (HMO D-SNP) are available to people who have Medicare and either receive Medicaid assistance from Commonwealth Coordinated Care Plus (Medicaid) or enrolled in a Medicare Savings Program in the state of Virginia. Synagis-Request-Form-VA. If a medication isn’t on the formulary, you can get coverage for up to a 34-day supply. com, email: VAProviderQuestions@MagellanHealth. If you don’t want to leave our site, choose the “X” in the upper right corner to close this message. By mail. 0/FAMIS: 1-800-279-1878, press * then option 1 CCC Plus: 1-855-652-8249, press * then option 1 For Addiction Recovery Treatment Services (ARTS) forms, visit our Materials and Forms page on our With our secure Member Portal, you can manage your Aetna Better Health® of Virginia plan benefits and easily change your doctor, get new ID cards, see your claim status, view your personal health history and more. 0 and Commonwealth Coordinated Care Plus (CCC Plus) into Cardinal Care Managed Care (CCMC). eviCore Healthcare performs utilization management services on behalf of Aetna Better Health of Virginia for the following programs: Musculoskeletal (pain management), Radiology Management (includes advanced imaging such as CT, MRI, MRA Health Plan Resources; Cardinal Care Compliance; Historical Information Expand sub pages Historical Information. If you have any questions about a drug that is not listed, please call Member Services at 1-855-463-0933 (TTY: 711) 8 AM to 8 PM, seven days a week. com,or. Each of the six (6) MCOs will be available in each of the six (6) regions. On October 1, 2023, Virginia Medicaid consolidated the two managed care programs of Medallion 4. For assistance in registering for or accessing this site, please contact your Provider Relations representative at 1-855-364-0974. If needed, you can get language services at no cost to you. com Please note: Incomplete forms or forms without the chart notes will be returned : Office notes, labs, and medical testing relevant to the request that show medical justification are required Standard turnaround time is 24 hours. Richmond, VA 23233 Aetna complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. . When conditions are met, we will authorize the coverage of Atypical Antipsychotics Less Than 18yrs (Medicaid). Sep 29, 2021 · All providers must register for the provider portal prior to use by completing and submitting our Portal Registration form. If you are already registered, you can just log in. When conditions are met, we will authorize the coverage of Weight Loss Agents (Medicaid). June 5, 2020 In April 2020, due to the COVID-19 pandemic, Aetna Better Health of Virginia put recoupment and recovery efforts on hold. Please note: Incomplete forms or forms without the chart notes will be returned Office notes, labs, and medical testing relevant to the request that show medical justification are required. Complete/review information, sign and date. You can call to check the status of a request . Aetna Better Health® of Virginia. Service Authorization is required for: All Long-Acting Opioids. Members can change health plans annually during open enrollment for any reason. 0. Our integrated care management program helps with your medical, behavioral and social needs. View the tool here. Care management and chronic disease management. Aetna Better Health® of Virginia CCC Plus and Medallion/FAMIS 4. This bulletin serves as an addendum to that memo -- it does not change the drugs or classes on the PDL (also called the Common Core Formulary) but instead provides notice about upcoming changes to service authorization criteria for certain weight-loss drugs. Everyone who is six months and older can get the COVID-19 Aug 1, 2022 · For credentialing and behavioral health service information, visit: www. Member Services: 24 hours a day, 7 days a week. Weight Loss Agents (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. 0 and Commonwealth Coordinated Care (CCC) Plus Phone Number Fax Number . 1. Medallion/FAMIS 4. Our plans are designed for people with special health care needs. Provider HELPLINE. Telling Aetna Better Health about changes in member’s family that might affect member’s eligibility or enrollment such as family size, employment, and moving out of the state of Virginia. Long-term services and supports (LTSS) Developmental disability (DD) waiver services. 0 Contracted Health Plans Aetna Better Health of Virginia Optima Health Plan Anthem HealthKeepers Plus UnitedHealthcare Magellan Complete Care of Virginia Virginia Premier Health Plan Pharmacy Prior Authorization AETNA BETTER HEALTH VIRGINIA CCC PLUS and MEDALLION/FAMIS 4. $15 Cervical cancer screening. Any Short-Acting Opioid prescribed for >7 days or two 7-day supplies in a 60-day period. Or choose “Go on” to move forward to Commonwealth Coordinated Care Plus (CCC Plus). Providers are to inform each health plan when the member has elected to not receive services Aetna Better Health Premier Plan MMAI works with certain subcontractors to coordinate services that are provided by entities other than the health plan, such as transportation, vision or dental services. Drug Name CCC Plus Open Enrollment. requested data must be provided. Ensure continuity of care between providers/locations. Monthly monitoring shall be performed by the CCC Plus managed care plan, or DMAS for fee-for-service (FFS), when the member does not receive a waiver service monthly. Drug Name (circle drug) Aetna Better Health® of Virginia CCC Plus and Medallion/FAMIS 4. data must be provided. When conditions are met, we will authorize the coverage of Zinbryta (Medicaid). P. Fax signed forms to Aetna Better Health Virginia CCC Plus and Medallion/FAMIS 4. Our population health management programs can help you live your healthiest life possible. Pharmacy Prior Authorization AETNA BETTER HEALTH VIRGINIA CCC PLUS and MEDALLION/FAMIS 4. We offer additional benefits and services not covered under Medicare, such as dental, hearing aids, and eyewear. Member materials and forms. Questions? Just call Member Services at 1-855-463-0933 (TTY: 711). Mar 19, 2020 · March 19, 2020, 12:00AM. To prevent delay in processing your request for services, please attach clinical documentation/medical records to support your request. This number is also included on each member’s ID card. Substance use disorders (SUDs) Aetna Better Health ® of Virginia. Help with special equipment and home health requests, including services for children. When conditions are met, we will authorize the coverage of Cough and Cold Products (Medicaid). Just call Member Services anytime to leave a message and we’ll return your call. Virginia combined its two existing managed care programs – Commonwealth Coordinated Care Plus (CCC Plus) and Medallion 4. When we receive the above information, we’ll send you your gift card. More about prior authorization Commonwealth Coordinated Care Plus (CCC Plus) provides the info on the next page. magellanofvirginia. 0 Antibiotics Oral (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. 0 REQUEST FORM HEPATITIS C ANTIVIRALS: Non-Preferred Fax back to 1-855-799-2553 . Call: 1-800-424-4046. CMS-1500 sample (PDF) To see a sample of a UB-04 form, check your provider manual (PDF). 1-800-279-1878 (TTY: 711) Hours and services. For after-hours or weekend questions, just choose the prior authorization option to leave a voicemail. It provides you with acute, chronic and long-term services and supports. Drug Name (please circle) Fax signed forms to Aetna Better Health Virginia CCC Plus and Medallion/FAMIS 4. Aetna Better Health® of Virginia You Can Change Your Health Plan Through the CCC Plus Helpline 26 Service Authorization and Benefit Determination Access the Aetna Better Health of Virginia provider portal for access to handbooks, claims information and more. Just press send. Aetna Better Health® of Virginia 9881 Mayland Drive Richmond, VA 23233 . C10557-A Effective: 01/01/2021 Page 1 of 2. To view our listing of noncovered drugs, step therapy requirements, pharmacy prior authorization requirements, or to request a drug that isn’t in our formulary, review the Provider Manual or contact the Pharmacy Department at 1-800-279-1878 (Medallion 4. You can call to check the status of a request. If the following information is not complete, correct, or Aetna Better Health of Virginia es parte de Aetna® y del grupo de CVS Health®, una de las principales organizaciones de cuidado de salud del país. 90-day supply list (PDF) Welcome to Aetna Better Health of Virginia You Can Change Your Health Plan Th rough the CCC Plus Helpline 25 Service Authorization and Benefit Determination 109 For more information or help selecting a plan, call the CCC Plus Helpline at 1-844-374-9159 (TTY: 1-800-817-6608), Monday - Friday from 8:30 a. Here, you’ll find the info and forms you need to get the most from your plan. Leave a voice mail message. MEMBER INFORMATION . Medicare-Medicaid plan forms. AetnaBetter Health also provides a toll‐free number for members at800‐279‐1878(FAMIS and Medallion), or 855‐652‐8249(CCCPLUS). Llevamos más de 30 años prestando servicios a quienes usan los servicios de Medicaid: niños, adultos y ancianos, e incluso personas con discapacidades u otros problemas de salud graves. To become eligible, you must’ve received two 30- to 34-day medication fills in the past 120 days. Multiple sclerosis. No prior authorization required! $15 Diabetic eye exams. 0/FAMIS) or 1-855-652-8249 (CCC Plus). Find all the materials and forms a member might need — right in one place. CCC Plus Expand sub pages CCC Plus. 1-800-552-8627. You can call Provider Relations at 1-800-279-1878 (TTY: 711). Program Information; Provider Resources; Health Plan Resources; Pharmacy; MCO Compliance Expand sub pages MCO Compliance. Medallion 4. From: Karen Kimsey, Director Department of Medical Assistance Services (DMAS) This memo sets out the Agency’s initial guidance on the flexibilities available to providers in light of the public health emergency presented by the COVID-19 virus. CVS Caremark Pharmacy Help Desk: 1- 866-386-7882. 0 Contract. $25 Initial colonoscopy. 0: 1-800-279-1878 CCC Plus: 1-855-652-8249 How to get started. CCC Plus - 1-855-652-8249 Commonwealth Coordinated Care Plus (CCC Plus) provides the info on the next page. To learn more, check your member handbook: Member handbook – English (PDF) Member handbook – Spanish (PDF) Member handbook – Arabic (PDF) Member handbook – Vietnamese (PDF) AETNA BETTER HEALTH ® OF VIRGINIA 9881 Mayland Dr. Health plans arrange support services based on a person’s unique needs. ) C10597-C _____ AETNA BETTER HEALTH® OF VIRGINIA CCC PLUS AND MEDALLION/FAMIS 4. Mark resubmitted claims clearly with “resubmission” to avoid denial as a duplicate. Immune deficiency. For care management, ask to speak to your care manager. Some conditions that need specialty medications include: Cancer. Coverage Guidelines are available at www. Please note that all authorization requests will be reviewed as the AB rated generic (when available) unless states otherwise. Other Important Contacts Mental Health Assistance Medallion 4. Just call ModivCare (formerly LogistiCare) directly at 1-800-734-0430 (TTY: 711). Referral source – Must be a physician, nurse practitioner or physician assistant who is the child’s primary care provider or another physician, nurse practitioner, or physician assistant provider familiar with the developmental history and current status of the child. You can send your grievance or appeal to: Aetna Better Health® of Virginia. Don’t forget: Space is limited and on a first-come, first-served basis. Ensure current and future members have the right info about your practice. Monday–Friday 8:00 a. Aetna Better Health of Virginia es parte de Aetna® y del grupo de CVS Health®, una de las principales organizaciones de cuidado de salud del país. When conditions are met, we will authorize the coverage of Sylatron (Medicaid). com/virginia . You can use the materials found there to determine which forms are required for LTSS authorization from Aetna Better Health® of Virginia. Once we receive your info, we’ll reach out to you. The Virginia BOM Regulations limit the treatment of acute pain with opioids to 7 days. When conditions are met, we will authorize the coverage of Lipotropics -Simcor (Medicaid). If covered services and those requiring prior authorization change, you will receive at least 60 days’ advance notice via provider newsletter, e-mail, updates to this website Fax signed forms to Aetna Better Health Virginia CCC Plus and Medallion/FAMIS 4. Hemophilia. Health programs. 0 – into one unified managed care program known as Cardinal Care Managed Care (CCMC). Box 982974 El Paso, TX 79998-2974 Mark resubmitted claims clearly with “resubmission” to avoid denial as a duplicate. LTSS helps older adults and people with disabilities live at home for as long as they can. 1-804-786-6273. Aetna Better Health of Virginia . No-cost smartphone. covered? This is Cardinal Care (Medicaid) coverage. When conditions are met, we will authorize the coverage of Cialis for BPH (Medicaid). They’re here for you 24 hours a day, 7 days a week. When conditions are met, we will authorize the coverage of Steroids Non-Preferred (Medicaid). If you have questions, just call Member If you have questions about what is covered, consult your provider handbook (PDF) or call 1-866-212-2851 (ICP) or 1‑866‑600-2139 (Premier Plan) for more information. Drug Name (please circle) Members can call 1-800-237-2767 (TTY: 711) with questions. How to get started. CONTACT INFORMATION . Phone. Stay accurate. ENGLISH: ATTENTION: If you speak English, language assistance services, free of charge, are available to you. You can have a say in your These reimbursement changes apply to fee-for-service claims processed by DMAS and managed care claims processed by Aetna Better Health of Virginia. Standard turnaround time is 24 hours. No prior authorization required! $25 Prostate cancer screening After your exam, just have your doctor complete the wellness rewards form below and fax it to us at 1-844-203-0020. Call Member Services. uu mk qe rn wo jp en pd vu vv