Update to the Durable Medical Equipment and Supplies Provider Manual, Chapter IV
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The purpose of this memorandum is to highlight changes and additions the Department of Medical Assistance Services (DMAS) made to Chapter IV of the Durable Medical Equipment (DME) and Supplies Manual. DME and supplies are a covered service available to the entire Medicaid population including both Fee for Service and Managed Care enrollees. Coverage criteria for Complex Rehabilitation Technology for members living in a nursing facility were added to the manual and are effective 1/1/2024. Changes were also made to update Face to Face HCPCS code list, Cardinal Care, Enteral Nutrition, Respiratory sections of the manual.
If providers are unsure of the appropriate code to use for a particular item, one resource is the DME classification site, which is designed to assist providers with DME coding. Providers can search by different criteria and by brand name. The website can be accessed at https://www.dmepdac.com/dmecsapp/do/search.
Please note: Appendix B of the Durable Medical Equipment (DME) and Supplies Provider Manual has been updated and is now available on the DMAS website (https://www.dmas.virginia.gov/for-providers/long-term-care/services/durable-medical-equipment/). All competitive bid rates are highlighted in blue.
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 |
Acentra Health 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. | |
Managed Care Programs Cardinal Care Managed Care 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. | |
Cardinal Care Managed Care | https://www.dmas.virginia.gov/for-providers/managed-care/cardinal-care-… |
PACE | |
Acentra Health Behavioral Health Services
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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 | https://www.aetnabetterhealth.com/virginia/providers/index.html 1-800-279-1878
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Anthem HealthKeepers Plus | 1-800-901-0020
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Molina Complete Care
| 1-800-424-4524 https://www.molinahealthcare.com/providers/va/medicaid/home.aspx
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Sentara Community Plan | 1-800-881-2166 https://www.sentarahealthplans.com/providers
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United Healthcare | 1-844-284-0149
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Dental Provider DentaQuest | 1-888-912-3456 |