Medicaid Updates

DMAS is aware of the issues that ABA providers are not being paid and are working with the MCOs to clear things up.  Here is a slide with some updates:

Although the date for auth and claims denials on that slide is end of March, Optima states that they should have the issue with denials for no authorizations in place solved by May 18.  Virginia Premier states that they are doing manual claims adjustments and should have issues solved by May 30.  Molina states they will have their claims issues solved by May 20.

Regarding the GT Modifier, United Healthcare and Va Premier state that they have solved this issue; Anthem states they will have issues solved by 5/31; and Optima, Molina, and Aetna are currently configuring systems.

The issue with respect to Place of Service (99 and 03), DMAS has rolled that out and it will take some time for the MCOs to process, but then they will reprocess claims.  There should be a clearer timeline by next week (w/o 5/16)

Finally, MCOs have been working on ways to tell consumers about providers.  Here are Aetna’s and Optima’s search engine.  Don’t forget, VABA also has a search engine: https://virginiaaba.org/provider-directory/ 

https://www.aetnabetterhealth.com/virginia/find-provider

https://www.optimahealth.com/providers/find-doctors-drugs-and-facilities

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