Changes in the Emergency Medical Certification process for Eligible Nonresident Aliens
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The purpose of this bulletin is to notify all providers participating in the Virginia Medicaid program of system changes affecting the Certification for Emergency Services process that applies to non-resident aliens who are eligible for emergency medical services only.
Effective July 1, 2022, the following aid categories will be assigned within DMAS’s Medicaid Enterprise System (MES) applicable to this population.
- Aid Category 112 Expansion population/MAGI Adults
- Aid Category 113 Non-MAGI/ABD/Children
For services provided on or after July 1, 2022, medical records and Emergency Medical Certification forms will no longer be required for Emergency Medical Certification. Providers will now submit claims for individuals enrolled with Aid Categories 112 and 113 directly to Conduent, the Department of Medical Assistance Services’ fiscal agent.
Billing instructions are available in Chapter 5 of the Medicaid Provider Manuals at:
https://vamedicaid.dmas.virginia.gov/manuals/provider-manuals-library
All claims must pass all system edits before payment.
Emergency Medical Certifications are processed in accordance with 12VAC30-50-310.
Some claims will require manual review and medical records will be requested from the provider if required for adjudication.
For more information on eligibility requirements for this group, consult the Virginia Medical Assistance Eligibility Manual Section M0220.000 Citizenship and Alien Requirements available at:
https://www.dmas.virginia.gov/for-applicants/eligibility-guidance/eligibility-manual/.
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PROVIDER CONTACT INFORMATION & RESOURCES |
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Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
Through March 29: www.virginiamedicaid.dmas.virginia.gov
As of April 4, 2022: https://login.vamedicaid.dmas.virginia.gov/ |
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Medicall (Audio Response System) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
1-800-884-9730 or 1-800-772-9996 |
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KEPRO Service authorization information for fee-for-service members.
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Provider Appeals DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal. |
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Provider Audits Please continue to adhere to all instructions provided via DMAS or its contractors as it relates to complying with audit processes and procedures. Conversion to MES will not affect audit protocol. |
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Managed Care Programs Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE). In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider. The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals. |
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Medallion 4.0 |
https://www.dmas.virginia.gov/for-providers/managed-care/medallion-40/ |
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CCC Plus |
https://www.dmas.virginia.gov/for-providers/managed-care/ccc-plus/ |
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PACE |
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Magellan Behavioral Health Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members. |
www.MagellanHealth.com/Provider For credentialing and behavioral health service information, visit: www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or Call: 1-800-424-4046 |
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Provider HELPLINE for claims assistance only as of March 26, 2022 Monday–Friday 8:00 a.m.-5:00 p.m. For provider use only, have Medicaid Provider ID Number available. |
1-804-786-6273 1-800-552-8627 |
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Provider Enrollment and Management Help Desk Monday–Friday 8:00 a.m.-5:00 p.m. For provider use only, have Medicaid Provider ID Number available. |
1-804-270-5105 1-888-829-5373
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Aetna Better Health of Virginia |
www.aetnabetterhealth.com/Virginia 1-800-279-1878 |
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Anthem HealthKeepers Plus |
1-800-901-0020 |
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Molina Complete Care
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1-800-424-4524 (CCC+) 1-800-424-4518 (M4) |
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Optima Family Care |
1-800-881-2166 www.optimahealth.com/medicaid |
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United Healthcare |
and www.myuhc.com/communityplan 1-844-752-9434, TTY 711 |
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Virginia Premier |
1-800-727-7536 (TTY: 711), www.virginiapremier.com |