VIVA Health has issued several provider updates covering telehealth, chronic care management, prescription costs, behavioral health billing, and provider enrollment. Telehealth benefits include primary and specialty care, mental health and psychiatric services, physical therapy, substance abuse services, and other eligible services, with claims requiring the appropriate procedure code and telehealth modifier along with POS 02 or POS 10.
VIVA Health also reminds providers that Chronic Care Management (CCM) services are provided through its VCare program and that provider-submitted CCM claims are not covered or billable to members. In addition, generic dapagliflozin moved from Tier 3 to Tier 1 for certain VIVA Medicare plans beginning June 1, 2026, reducing the average monthly cost by $42.
Providers billing CPT 90837 for 60-minute psychotherapy services should maintain accurate start and stop times, document medical necessity and therapeutic interventions, and ensure the billed time meets the minimum 53-minute requirement. VIVA Health notes that incomplete documentation, upcoding, or billing for services not provided can result in denials, audits, repayment demands, or other compliance issues.
Additional updates include the upcoming Medicare Annual Enrollment Period from October 15 through December 7, a new online provider application replacing the previous paper form, procedures for submitting demographic changes, and required annual Special Needs Plan Model of Care training for providers caring for dual-eligible members.
Resource: Viva Health