Search For:

In accordance with § 54.1-2952 et seq., effective September 1, 2021, qualified Physician Assistants (PA) practicing in accordance with 18VAC85-50-101 may enroll with the Department of Medical Assistance Services (DMAS) as fee-for-service participating provider class type “Physician Assistant” and claim reimbursement for providing covered services to Medicaid and FAMIS members.

In accordance with § 54.1-2957 et seq., effective September 1, 2021, qualified Nurse Practitioners (NP) practicing as Certified Registered Nurse Anesthetists (CRNA) in accordance with 18VAC90-30-121 may enroll with DMAS with the specialty of CRNA and claim reimbursement for providing covered anesthesia services to Medicaid and FAMIS members.

These changes affect DMAS fee-for-service enrollment and claims only, and do not affect DMAS’ requirements for contracted Managed Care Organizations’ (MCO) network management policies and procedures.

Qualified Certified Registered Nurse Anesthetists (CRNAs)

Qualified CRNAs are advanced practice registered nurses jointly licensed by the Virginia Department of Health Professions’ Boards of Medicine and Nursing as nurse practitioners certified in the specialty of nurse anesthesia, and who practice under the supervision of a doctor of medicine, osteopathy, podiatry or dentistry consistent with the Code of Virginia. Qualified CRNAs participating with DMAS must follow all policies set forth in the DMAS Physician/Practitioner Manual.

Covered Services

Participating CRNAs may be reimbursed for those medical care services that are within the scope of practice and proficiency of the supervising physician in compliance with the Virginia Code and regulations.

Qualified Physician Assistants (PAs)

Qualified PAs are healthcare professionals licensed by the Virginia Department of Health Professions’ Board of Medicine practicing under supervision of a doctor of medicine, osteopathy or podiatry consistent with the Code of Virginia. Qualified PAs participating with DMAS must follow all policies set forth in the DMAS Physician/Practitioner Manual.

Covered services

Participating PAs may be reimbursed for those medical care services that are within the scope of practice and proficiency of the supervising physician as prescribed in the physician assistant's practice agreement in compliance with Virginia code and regulations.

Payment rates

Current reimbursement rates for covered services under the fee-for-service program can be accessed through the DMAS public website at https://www.virginiamedicaid.dmas.virginia.gov/.

Enrollment

Qualified CRNAs and PAs enrolling with DMAS will be required to obtain a National Provider Identifier (NPI) through the National Plan and Provider Enumeration System (NPPES). (More information can be found at nppes.cms.hhs.gov.) After obtaining an NPI, CRNAs and PAs must submit a completed provider enrollment package to Conduent, the fiscal agent for Virginia’s Medical Assistance Program administering all provider enrollment functions for Virginia Medicaid. The enrollment package is available online at https://www.virginiamedicaid.dmas.virginia.gov. Please create an account by registering as a provider. Once you register, you can access the applications through the provider enrollment link. Select the appropriate application based on provider type and submit the enrollment application online.

CRNAs and PAs will be subject to the provider review and audit process, as are all Medicaid enrolled health care providers.

"HELPLINE"

The "HELPLINE" is available Monday through Friday from 8:00 a.m. to 5:00 p.m., except on state holidays, to answer questions. The "HELPLINE" numbers are:

• 1-804-786-6273          Richmond area and out-of-state long distance
• 1-800-552-8627          All other areas (in-state, toll-free long distance)

Please remember that the "HELPLINE" is for provider use only. Please have your Medicaid provider identification number available when you call.

*************************************************************************************