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

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Memo

August 28, 2023, 12:07PM

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