Managed care plans to assist enrollees in completing the Medicaid renewal process
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The purpose of this bulletin is to notify providers that CMS has approved a request from DMAS to allow managed care organizations (MCOs) to assist enrollees in completing the Medicaid renewal process, including completing certain parts of the renewal forms, to help reduce the number of procedural terminations during the state’s Return to Normal Operations period.
This flexibility is in effect immediately and will be in effect through February 28, 2024.
MCOs and MCO employees must adhere to guidelines when performing this work, including:
Complete the Sign Up Now (SUN) renewal training prior to assisting any individual with a paper renewal packet or CommonHelp redetermination process.
Only assist with renewals that have been initiated by the state.
Not assisting with any application fields associated with managed care plan selection.
Not acting as the enrollee’s authorized representative.
Not performing activities that must be provided by an enrollment broker, including choice counseling.
Avoid all forms of marketing and potential conflicts of interest and protect managed care enrollees’ confidentiality.
Tracking and reporting on all activities.
Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. | |
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 |
Acentra Health 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. | |
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 | |
CCC Plus | |
PACE | |
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 www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or Call: 1-800-424-4046 |
Provider Enrollment | In-State: 804-270-5105 Out of State Toll Free: 888-829-5373 Email: VAMedicaidProviderEnrollment@gainwelltechnologies.com |
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 |
Aetna Better Health of Virginia | www.aetnabetterhealth.com/Virginia 1-855-270-2365 1-866-386-7882 (CCC+) |
Anthem HealthKeepers Plus | 1-833-207-3120 1-833-235-2027 (CCC+) |
Molina Complete Care
| 1-800-424-4524 (CCC+) 1-800-424-4518 (M4) |
Optima Family Care | 1-800-643-2273 1-844-374-9159 (CCC+) |
United Healthcare | 1-844-284-0149 1-855-873-3493 (CCC+) |
Dental Provider DentaQuest | 1-888-912-3456 |