Update of Coverage of Routine Contraceptives
Download PDF
The purpose of this bulletin is to inform providers of an update to coverage of routine contraceptives. In accordance with Item 313.YYYYY of the 2021 Special Session I Appropriations Act, DMAS and all contracted managed care plans will cover up to 12 months of contraceptives for Medicaid, FAMIS, and Plan First Members, effective July 1, 2021. A valid prescription for 12 months of coverage is required.
Information on specific medications may be accessed through the drug lookup tool for fee-for-service Members (see https://www.virginiamedicaidpharmacyservices.com/provider/drug-lookup). For questions on coverage for members enrolled in a managed care organization, refer to the relevant MCO formulary on the websites indicated below.
The purpose of this bulletin is to inform providers of an update to coverage of routine contraceptives. In accordance with Item 313.YYYYY of the 2021 Special Session I Appropriations Act, DMAS and all contracted managed care plans will cover up to 12 months of contraceptives for Medicaid, FAMIS, and Plan First Members, effective July 1, 2021. A valid prescription for 12 months of coverage is required.
*************************************************************************************
|
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. |
|
|
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.
|
|
|
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. |
|
|
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 |
|
|
CCC Plus |
|
|
PACE |
|
|
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 |
1-800-901-0020 |
|
Magellan Complete Care of Virginia |
1-800-424-4518 (TTY 711) or 1-800-643-2273 |
|
Optima Family Care |
1-800-881-2166 www.optimahealth.com/medicaid |
|
United Healthcare |
and www.myuhc.com/communityplan 1-844-752-9434, TTY 711 |
|
Virginia Premier |
1-800-727-7536 (TTY: 711), www.virginiapremier.com |