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The purpose of this bulletin is to explain upcoming changes to the provider appeal process. The General Assembly directed DMAS to promulgate regulations to require providers to utilize DMAS’ appeal portal for the appeal process unless a good cause exception is requested and granted (Item 292 QQ of the 2025 Appropriations Act). These regulations will go into effect on November 5, 2026. Additionally, Chapter II of all Provider Manuals will be revised with an effective date of November 5, 2026.

The DMAS appeal portal is known as the Appeals Information Management System (“AIMS”). It first launched in May 2021, allowing Medicaid providers and clients to file their appeals online, upload documents, and track the status of their cases.  Information about AIMS is available at https://dmas.virginia.gov/appeals/.

At the present time, DMAS accepts appeals filed by AIMS, U.S. Mail/delivery, email, and fax. With the regulatory change, AIMS will be the only method that appeals will be accepted and processed, unless a good cause exception is requested and granted.  Since this alters long-standing practice, DMAS is affording providers approximately a two-month grace period and will continue to accept appeals through all methods until the end of 2026.  Strict enforcement of the online requirements will begin on January 1, 2027.  Documents sent by mail/delivery, email, and fax, and received by DMAS on and after January 1, 2027, will not be processed unless the submission includes a good cause request that is granted by DMAS.  Unless the exception is granted, providers must use AIMS to file the appeal, upload documents, and receive notifications from DMAS about the appeal process.

Providers requesting an exception must do so before the appeal deadline by sending the exception request by mail (DMAS, Attn: Appeals Division, 600 East Broad Street, Richmond, VA  23219) or email (appeals@dmas.virginia.gov).  The request must have a subject of “Exception Request for Portal Filing.”  For emails, this must be in the subject line.  For delivered requests, this must be underneath the address block on the cover letter.  Exceptions will be granted for good cause shown. Examples of good cause include:

1. The infrastructure necessary to support electronic submission is not available in the provider's geographic region;

2. The disability of all members of a provider's staff prevents their use of AIMS; or

3. The provider cannot transmit documents through AIMS due to unusual or unavoidable circumstances.

Because exception requests will only be permitted in those limited circumstances, DMAS encourages all providers to immediately begin utilizing AIMS if they are not already doing so.  The first step is to register for an AIMS account.  In order to comply with the Health Insurance Portability and Accountability Act (HIPAA), DMAS must verify that the individual registering is affiliated with the requested provider(s).  Therefore, to allow DMAS time to process the request, providers should submit a registration request well in advance of the appeal deadline.  DMAS recommends that provider staff who may need to file an appeal in the future submit a registration request upon receipt of this Bulletin.

Once a registration request is approved, that individual will be able to log into AIMS to create a new appeal, upload documents to existing appeals, and track the status of appeals for the providers/firms for which they have been approved.  File sizes greater than one gigabyte may not be able to be uploaded to AIMS. Providers can, however, break up a large file into multiple small files and upload them individually that way. Once an appeal has been filed, AIMS will send an email when new documents have been added to the appeal by DMAS or a DMAS contractor.

In summary, providers who have not yet used AIMS should take the following actions as soon as possible:

1. Disseminate this memo to all staff and contractors who file appeals on their behalf.

2. Ensure staff and contractors register for AIMS at https://appeals-registration.dmas.virginia.gov/provider as soon as possible.

3. Become familiar with the AIMS dashboards and appeal filing experience.

4. Contact DMAS’ AIMS Help via email at AIMSHelp@DMAS.Virginia.Gov, or by phone at (804) 486-2865, if there are any technical difficulties.

DMAS is committed to making sure this is a smooth transition for all providers. However, as this is a General Assembly mandate, DMAS must ensure full compliance by January 1, 2027.

Please note: The online requirements do not apply to Medicaid applicants, members, and their authorized representatives who request State Fair Hearings.

The DMAS appeal portal is known as the Appeals Information Management System (“AIMS”). It first launched in May 2021, allowing Medicaid providers and clients to file their appeals online, upload documents, and track the status of their cases.  Information about AIMS is available at https://dmas.virginia.gov/appeals/. 

At the present time, DMAS accepts appeals filed by AIMS, U.S. Mail/delivery, email, and fax. With the regulatory change, AIMS will be the only method that appeals will be accepted and processed, unless a good cause exception is requested and granted.  Since this alters long-standing practice, DMAS is affording providers approximately a two-month grace period and will continue to accept appeals through all methods until the end of 2026.  Strict enforcement of the online requirements will begin on January 1, 2027.  Documents sent by mail/delivery, email, and fax, and received by DMAS on and after January 1, 2027, will not be processed unless the submission includes a good cause request that is granted by DMAS.  Unless the exception is granted, providers must use AIMS to file the appeal, upload documents, and receive notifications from DMAS about the appeal process. 

Providers requesting an exception must do so before the appeal deadline by sending the exception request by mail (DMAS, Attn: Appeals Division, 600 East Broad Street, Richmond, VA  23219) or email (appeals@dmas.virginia.gov).  The request must have a subject of “Exception Request for Portal Filing.”  For emails, this must be in the subject line.  For delivered requests, this must be underneath the address block on the cover letter.  Exceptions will be granted for good cause shown. Examples of good cause include:

1. The infrastructure necessary to support electronic submission is not available in the provider's geographic region;

2. The disability of all members of a provider's staff prevents their use of AIMS; or

3. The provider cannot transmit documents through AIMS due to unusual or unavoidable circumstances.

Because exception requests will only be permitted in those limited circumstances, DMAS encourages all providers to immediately begin utilizing AIMS if they are not already doing so.  The first step is to register for an AIMS account.  In order to comply with the Health Insurance Portability and Accountability Act (HIPAA), DMAS must verify that the individual registering is affiliated with the requested provider(s).  Therefore, to allow DMAS time to process the request, providers should submit a registration request well in advance of the appeal deadline.  DMAS recommends that provider staff who may need to file an appeal in the future submit a registration request upon receipt of this Bulletin. 

Once a registration request is approved, that individual will be able to log into AIMS to create a new appeal, upload documents to existing appeals, and track the status of appeals for the providers/firms for which they have been approved.  File sizes greater than one gigabyte may not be able to be uploaded to AIMS. Providers can, however, break up a large file into multiple small files and upload them individually that way. Once an appeal has been filed, AIMS will send an email when new documents have been added to the appeal by DMAS or a DMAS contractor. 

In summary, providers who have not yet used AIMS should take the following actions as soon as possible:

1. Disseminate this memo to all staff and contractors who file appeals on their behalf.

2. Ensure staff and contractors register for AIMS at https://appeals-registration.dmas.virginia.gov/provider as soon as possible.

3. Become familiar with the AIMS dashboards and appeal filing experience.

4. Contact DMAS’ AIMS Help via email at AIMSHelp@DMAS.Virginia.Gov, or by phone at (804) 486-2865, if there are any technical difficulties.

DMAS is committed to making sure this is a smooth transition for all providers. However, as this is a General Assembly mandate, DMAS must ensure full compliance by January 1, 2027.

Please note: The online requirements do not apply to Medicaid applicants, members, and their authorized representatives who request State Fair Hearings.