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Reimbursement for COVID services under Emergency Medicaid after the end of the federal Public Health Emergency

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Bulletin
Effective Date:

To:
All Providers, Contractors, and Managed Care Organizations (MCOs) Participating in the Virginia Medicaid and FAMIS Programs
From:
Cheryl J. Roberts, Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to inform providers that automatic coverage for COVID-19 testing, vaccinations, and/or treatment for individuals covered by Emergency Medicaid - as stipulated by Virginia Acts of Assembly 2021 Special Session I, Chapter 476 (HB 2124) - will end on May 11, 2023, due to the end of the COVID-19 federal public health emergency. Prior to the above-referenced legislative requirement, COVID testing, vaccination and/or treatment services were reimbursed only if those services were provided as part of an episode of care that qualified for DMAS reimbursement under Emergency Medicaid. Effective March 23, 2022, COVID-related services could be reimbursed regardless of whether an episode of care qualified for DMAS reimbursement under Emergency Medicaid, as described in a Bulletin published November 3, 2022.  Effective May 11, 2023, COVID testing, vaccination and/or treatment services will be reimbursed only if those services are provided as part of an episode of care that qualifies for DMAS reimbursement under Emergency Medicaid.

 

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.

https://vamedicaid.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 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.

https://www.dmas.virginia.gov/appeals/

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 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

www.anthem.com/vamedicaid

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+)

 www.optimahealth.com/medicaid

United Healthcare

www.Uhccommunityplan.com/VA

www.myuhc.com/communityplan

1-844-284-0149

1-855-873-3493 (CCC+)

Virginia Premier

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

Dental Provider

DentaQuest

1-888-912-3456