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New FAMIS Prenatal Coverage for Pregnant Individuals Previously Ineligible Due to Immigration Status

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Bulletin
Effective Date:

To:
All Providers Participating in the Virginia Medicaid and FAMIS Programs and Managed Care Organizations
From:
Karen Kimsey, Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to alert Medicaid and FAMIS providers and managed care organizations to a change in Virginia policy that was made in the 2021 Special Session I Appropriations Act, which extends FAMIS Prenatal coverage to certain individuals who were previously ineligible.

In accordance with Item 312.H. of the Act, as of July 1, 2021, pregnant individuals of any age who do not meet other covered groups due to their immigration status may be eligible for this new coverage from the time the pregnant individual applies through sixty (60) days postpartum. All other eligibility requirements must still be met. Individuals enrolled in the FAMIS Prenatal Coverage will receive the same coverage as FAMIS MOMS and will be enrolled in managed care in the same manner as other pregnant individuals.

Individuals are encouraged to apply in one of the following ways for an eligibility determination:

How to Apply for Health Insurance Programs in Virginia

Apply online at CommonHelp

Go to https://commonhelp.virginia.gov

OR

Call 1-855-242-8282 (toll free).

Translation and interpreter services are available.

OR

Through their local department of social services.

Go to https://www.dss.virginia.gov/localagency/index.cgi for contact information.

 

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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

KEPRO

Service authorization information for fee-for-service members.

 

 

https://dmas.kepro.com/

 

Provider Appeals

DMAS is launching an appeal portal in late May 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. 

https://www.dmas.virginia.gov/#/appealsresources

 

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

Aetna Better Health of Virginia

www.aetnabetterhealth.com/Virginia

 1-800-279-1878

Anthem HealthKeepers Plus

www.anthem.com/vamedicaid

1-800-901-0020

Magellan Complete Care of Virginia

www.MCCofVA.com

 1-800-424-4518 (TTY 711) or 1-800-643-2273

Optima Family Care

1-800-881-2166 www.optimahealth.com/medicaid

United Healthcare

www.Uhccommunityplan.com/VA

and www.myuhc.com/communityplan

1-844-752-9434, TTY 711

Virginia Premier

1-800-727-7536 (TTY: 711), www.virginiapremier.com