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Removal of Co-Payments for Medicaid and FAMIS Enrollees

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

The purpose of this memo is to inform providers that, as of April 1, 2022, the Department of Medical Assistance Services (DMAS) and its managed care organizations (MCOs) removed co-payments for Medicaid and FAMIS enrollees, in accordance with Item 304.FFFF of the 2022 Virginia Appropriations Act. As a result, co-pays will not resume after the end of the Federal Public Health Emergency. DMAS will update the following provider manuals to reflect the elimination of co-payments as described in this memo.

  • Addiction and Recovery Treatment Services: Chapter IV
  • Durable Medical Equipment: Chapter II
  • Home Health: Chapter II
  • Home Health: Chapter IV
  • Hospice: Chapter II
  • Hospital: Chapter IV

 

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 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

www.anthem.com/vamedicaid

1-800-901-0020

Molina Complete Care

 

1-800-424-4524 (CCC+)

1-800-424-4518 (M4)

Optima Family Care

1-800-881-2166 www.optimahealth.com/medicaid

United Healthcare

www.Uhccommunityplan.com/VA

and www.myuhc.com/communityplan

1-844-752-9434, TTY 711

Virginia Premier

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