1. Molina Spring Workshop
AETNA BETTER HEALTH® OF WEST VIRGINIA
April 2018

2. Our Core Values . 1

3. Provider Relations Update
Provider Relations phone line is now staffed by live agents
If all agents are busy, providers can leave a voic and calls will be returned within 24 hours
Warm transfer process from Provider Service line 2

4. Provider Webinars RSVP to your Provider Relations Representative
New Provider Orientation Webinar – the last Thursday of every month at 11:00 am.
Quarterly Existing Provider Education/Updates Webinars –June 28, September 27, December 27, 2018 at 1:00 pm.
RSVP to your Provider Relations Representative 3

5. Corrected Claims and Resubmissions Update
Effective February 1, 2018, the time frame Practitioners and Providers have to file corrected claims and resubmissions changed from 90 days from the date of the original remittance advice to 120 days.
Practitioners and providers may resubmit a claim that:
Was originally denied because of missing documentation, incorrect coding, etc. 4

6. Coming soon…. IVR – Internal Voice Recognition - Self Serve Option
Expected roll out will be second quarter 2018
You will be able to get member eligibility information
Members will be able to request ID cards
Members can change their PCPs
You can get Prior Authorization header status
If the system cannot answer your question, it will go to a representative with a pop-up of the information you provided 5

7. New Provider Resource for Peer to Peer Requests
Effective September 15, 2017, providers have a new resource for making Peer to Peer Requests for Aetna Better Health of WV. 
Please call to contact our Health Services/Medical Management Department directly with your request. 6

8. Community Psychiatric Supportive Treatment Policy Update
Effective March 1, 2018, Aetna Better Health of West Virginia will require notification and clinical information after three days (144 units) of treatment. This will enable our medical management team to anticipate the needs of the member and assist in discharge planning and coordination of care.
The first three days (144 units) of Community Psychiatric Supportive Treatment will not require notification or authorization of services
Continued treatment after three days (144 units) will require prior authorization 7

9. Drug Screening Policy Update
Effective October 1, 2017, for all places of service except inpatient claims for G0481, G0482, G0483, and G0659 require medical records that explicitly substantiate the medical necessity of testing for more than 7 drug classes. Further, reimbursement for G0480 requires documentation of a presumptive test within 5 business days of the date of service.  8

10. Drug Screening Policy Update
Effective May 14, 2018, for all places of service except inpatient G0480, G0481, G0482, G0483, and G0659 will require prior authorization.
Presumptive Drug Testing Codes: 80305, 80306, and 80307
Definitive Drug Testing Codes: G0480, G0481, G0482, G0483, and G0659 9

11. Thank you