New FAMIS Prenatal Coverage for Pregnant Individuals Previously Ineligible Due to Immigration Status
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The purpose of this bulletin is to alert Medicaid and FAMIS providers and managed care organizations to a change in Virginia policy that was made in the 2021 Special Session I Appropriations Act, which extends FAMIS Prenatal coverage to certain individuals who were previously ineligible.
In accordance with Item 312.H. of the Act, as of July 1, 2021, pregnant individuals of any age who do not meet other covered groups due to their immigration status may be eligible for this new coverage from the time the pregnant individual applies through sixty (60) days postpartum. All other eligibility requirements must still be met. Individuals enrolled in the FAMIS Prenatal Coverage will receive the same coverage as FAMIS MOMS and will be enrolled in managed care in the same manner as other pregnant individuals.
Individuals are encouraged to apply in one of the following ways for an eligibility determination:
How to Apply for Health Insurance Programs in Virginia
Apply online at CommonHelp
Go to https://commonhelp.virginia.gov
OR
Call 1-855-242-8282 (toll free).
Translation and interpreter services are available.
OR
Through their local department of social services.
Go to https://www.dss.virginia.gov/localagency/index.cgi for contact information.
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PROVIDER CONTACT INFORMATION & RESOURCES |
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Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
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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 |
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KEPRO Service authorization information for fee-for-service members.
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Provider Appeals DMAS is launching an appeal portal in late May 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/#/appealsresources
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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. |
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Medallion 4.0 |
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CCC Plus |
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PACE |
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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 |
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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 |
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Aetna Better Health of Virginia |
www.aetnabetterhealth.com/Virginia 1-800-279-1878 |
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Anthem HealthKeepers Plus |
1-800-901-0020 |
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Magellan Complete Care of Virginia |
1-800-424-4518 (TTY 711) or 1-800-643-2273 |
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Optima Family Care |
1-800-881-2166 www.optimahealth.com/medicaid |
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United Healthcare |
and www.myuhc.com/communityplan 1-844-752-9434, TTY 711 |
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Virginia Premier |
1-800-727-7536 (TTY: 711), www.virginiapremier.com |