Top Mobile Menu Bottom Mobile Menu

Search For:

Update to Physician-Practitioner Manual, Chapters 4 and 5; and Hospital Manual, Chapter 5

Download PDF Download PDF
Memo
Effective Date:

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

The purpose of this memorandum is to notify providers that updates have been made to Chapters 4 and 5 of the Physician-Practitioner Manual and Chapter 5 of the Hospital Manual.

The changes include:

  •      Substantial reorganization and updates to Chapters 4 and 5 of the Physician-Practitioner manual to reflect current practices.

  •     Re-naming the Physician-Practitioner Manual to the Practitioner Manual to reflect that the manual includes services provided by several types of licensed health care practitioners. 

Changes made to each of these chapters to remove text related to Item 313.AAAAA of the 2020 Acts of Assembly.  This text is being removed in recognition of a federal court order (Va. Hosp. & Healthcare Assoc. et al. v. Roberts et al., No. 3:20-cv-00587-HEH).

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

Acentra Health 

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

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+)

Dental Provider

DentaQuest

1-888-912-3456