No requirement for exclusive telemedicine providers to maintain a physical presence in Virginia/in-state address
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The purpose of this bulletin is to notify all providers that, pursuant to Virginia Acts of Assembly 2023, Chapter 112 (HB 1602, SB 1418), 1) licensed health care providers who provide health care services exclusively through telemedicine are not required to maintain a physical presence in the Commonwealth to be considered an eligible provider for enrollment as a Medicaid provider and 2) telemedicine services provider groups with licensed health care providers are not required to have an in-state service address to be eligible to enroll as a Medicaid vendor or Medicaid provider group. Providers wishing to enroll can access DMAS’s online provider enrollment process through the Provider Enrollment link located on the DMAS Medicaid Enterprise System (MES) Provider Resources site at https://vamedicaid.dmas.virginia.gov/provider.
These requirements align with the Department of Medical Assistance Services’ current telemedicine policies which can be found in the Telehealth Services Supplement that is attached to several Provider Manuals. Therefore, DMAS and its Managed Care Organizations (MCOs) are in compliance with the Virginia Acts of Assembly 2023, and forthcoming policy changes will not be needed.
In-state telemedicine providers will continue to need to meet the Virginia Department of Health Profession’s (DHP’s) licensing requirement and out-of-state telemedicine providers need to continue to meet DHP’s licensing requirements in addition to their state licensing requirements to provide telemedicine services to Virginia Medicaid members.
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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. |
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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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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 |
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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 Enrollment |
In-State: 804-270-5105 Out of State Toll Free: 888-829-5373 Email: VAMedicaidProviderEnrollment@gainwelltechnologies.com |
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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 |
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Aetna Better Health of Virginia |
www.aetnabetterhealth.com/Virginia 1-855-270-2365 1-866-386-7882 (CCC+) |
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Anthem HealthKeepers Plus |
1-833-207-3120 1-833-235-2027 (CCC+) |
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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 |
1-800-643-2273 1-844-374-9159 (CCC+) |
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United Healthcare |
1-844-284-0149 1-855-873-3493 (CCC+) |
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Virginia Premier |
1-800-727-7536 (TTY: 711), www.virginiapremier.com |
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Dental Provider DentaQuest |
1-888-912-3456 |