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Federally Qualified Health Centers Coverage of Telemedicine

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Bulletin
Effective Date:

To:
Federally Qualified Health Centers Coverage of Telemedicine
From:
Jennifer S. Lee, M.D., Director DMAS

The purpose of this bulletin is to clarify the Department of Medical Assistance Services’ (DMAS) policy regarding telemedicine coverage, specifically as it relates to Federally Qualified Health Centers (FQHCs). The clarification is that FQHCs may bill DMAS for services delivered via telemedicine, both as an originating site or as a remote site.

Please refer to the May 13, 2014 Medicaid memo entitled, “Updates to Telemedicine Coverage,” for additional guidance. The memo includes key telemedicine definitions and requirements related to enrollment, billing, allowed services and providers, as well as guidance regarding individual contracts between FQHCs and Managed Care Organizations (MCOs) under contract to DMAS.  

If the individual is enrolled in managed care, providers should direct coverage questions to the specific MCO in question.

Medicaid Expansion

New adult coverage begins January 1, 2019.  Providers will use the same web portal and enrollment verification processes in place today to verify Medicaid expansion coverage.  In ARS, individuals eligible in the Medicaid expansion covered group will be shown as “MEDICAID EXP.”  If the individual is enrolled in managed care, the “MEDICAID EXP” segment will be shown as well as the managed care segment, “MED4” (Medallion 4.0), or “CCCP” (CCC Plus).  Additional Medicaid expansion resources for providers can be found on the DMAS Medicaid Expansion webpage at:  http://www.dmas.virginia.gov/#/medex.  

PROVIDER CONTACT INFORMATION & RESOURCES

Virginia Medicaid Web Portal Automated

Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

www.virginiamedicaid.dmas.virginia.gov

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

 

Medicaid Bulletin: Federally Qualified Health Centers Telemedicine Coverage  

March 4, 2019 Page 2

 

KEPRO

Service authorization information for fee-forservice members.

https://dmas.kepro.com/

 

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.

Medallion 4.0

http://www.dmas.virginia.gov/#/med4

CCC Plus

http://www.dmas.virginia.gov/#/cccplus

PACE

http://www.dmas.virginia.gov/#/longtermprograms

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

 

 

Provider HELPLINE

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