Revised Outpatient Hospital Rates – Effective July 1, 2022
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The purpose of this bulletin is to notify providers that the rates for outpatient hospitals have been revised for state fiscal year 2023 (SFY23) effective for dates of service on or after July 1, 2022. Enhanced Ambulatory Patient Groups (EAPG) base rates have been recalculated to include all claim experience data in accordance with 12VAC30-80-36. There will be no changes to the EAPG grouper version 3.16 weights. The Department of Medical Assistance Services (DMAS) will reprocess Fee-For-Service claims.
SFY 2023 Rate Notification
All EAPG rates will be posted on the DMAS website here and will be considered official notification.
For questions about hospital reimbursement, please contact the DMAS help line at 1-800-552-8627.
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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 |