Aetna Better Health of Virginia Updates Cardinal Care Billing Requirements

On September 9, 2026, Aetna Better Health of Virginia posted a provider notification titled “Billing Requirements Update.” It revises the billing-and-claims language in Chapter 13 of its Cardinal Care Provider Manual. For Adult Day Health Care providers billing Aetna under Cardinal Care / CCC Plus LTSS, the operational change is about timely filing when the member already gave you what you need to verify Medicaid enrollment — not a new claim format.

ElderSuite serves adult day care centers nationwide. This piece is Virginia / Aetna Better Health–specific.

What Aetna changed on September 9

The notice is on Aetna’s Provider Notices & Newsletters page under September 2026. It points providers to the revised language in the Aetna Better Health of Virginia Provider Manual (PDF) Chapter 13 — Billing and Claims.

Under the updated language, providers and their billing vendors must submit claims for medically necessary Medicaid-covered services when the member has provided the information needed to verify Medicaid enrollment at least 21 days before the provider’s claim-submission deadline. If the provider fails to submit the claim under those circumstances, the provider may not bill the member and may not pursue reimbursement rights or liens against the member.

Contact for the notice: Provider Services at 1-800-279-1878 (TTY: 711).

Why Adult Day Care providers should care

Aetna’s Cardinal Care / CCC Plus LTSS coverage expressly includes Adult Day Health Care among covered waiver services (see Aetna’s Cardinal Care Member Handbook (PDF)). Virginia centers already billing ADHC under S5102 should treat this as a claims-timing and balance-billing rule, alongside the hourly ADHC rates covered in Virginia Medicaid S5102 Hourly Billing for Adult Day Health Care.

What did not change

Nothing in the September 9 notice changes a payer ID, procedure code, claim segment, units calculation, or clearinghouse connection. Aetna continues to direct providers to Availity for claims-related workflows.

Aetna’s current claims guidance still gives providers 365 calendar days from the date of service to file a medical claim unless the contract specifies an exception (Participating Provider Quick Reference Guide (PDF)). That same guidance continues to require billing and rendering taxonomy codes consistent with the provider’s DMAS registration (Claims and Encounters Front-End Edits (PDF)).

What this means for ElderSuite users

This is an operational / timely-filing compliance issue, not an 837P-format or connectivity change. There is no ElderSuite software change from this notice. Centers should keep filing Aetna Virginia claims on schedule when eligibility information is already on hand, and treat a missed deadline under those circumstances as provider financial responsibility rather than a path to bill the member.

For the broader electronic claim workflow from attendance through clearinghouse submission, see Medicaid Billing for Adult Day Care: A Practical Guide. For common claim problems before and after submission, see Adult Day Care Claim Denials: Common Causes and How to Prevent Them.

What to do now

• Read the September 9, 2026 Billing Requirements Update and the revised Chapter 13 language in Aetna’s Provider Manual.
• Confirm your claim-submission deadline under your Aetna Virginia provider agreement (365 days from date of service unless your contract says otherwise).
• When a member has already supplied the information needed to verify Medicaid enrollment at least 21 days before that deadline, file the medically necessary covered claim — do not plan to balance-bill the member if you miss it.
• Keep billing and rendering taxonomy codes consistent with DMAS registration; Availity remains Aetna’s claims workflow path.
• Call Aetna Provider Services at 1-800-279-1878 (TTY: 711) with plan-specific questions.

Sources

• Aetna Better Health of Virginia — Provider Notices & Newsletters (September 9, 2026 Billing Requirements Update; current as of September 10, 2026)
• Aetna Better Health of Virginia Provider Manual (PDF) — Chapter 13 Billing and Claims (linked from the September 9 notice)
• Participating Provider Quick Reference Guide (PDF) — 365-day medical claim filing limit
• New Aetna Better Health Claims and Encounters Front-End Edits (PDF) — taxonomy / DMAS registration edits
• Cardinal Care Member Handbook (PDF) — Adult Day Health Care among covered services