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DMAS Pharmacy and Therapeutics (P&T) Committee Meeting Frequency

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Bulletin
Effective Date:

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

The purpose of this bulletin is to inform the provider community of the change in frequency of the DMAS P&T Committee meetings. The current bylaws state that P&T meetings are to be held at least biannually. 

 

DMAS has made the decision to meet quarterly to allow for more regular review of new drugs and evidence to ensure that the Common Core Formulary (CCF) remains up to date with the latest evidence. The increased frequency will also ensure that all stakeholders stay informed on new medications and guidelines while promoting alignment between DMAS and their Managed Care Organizations (MCOs). 

 

All DMAS meetings and their respective agendas will continue to be available to the public at: https://townhall.virginia.gov/l/meetings.cfm 

 

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

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

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

Program of All-inclusive Care (virginia.gov)

Acentra Health 

Behavioral Health Services

 

https://vamedicaid.dmas.virginia.gov/sa  

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

 

Anthem HealthKeepers Plus 

http://www.anthem.com/

1-800-901-0020

 

Molina Complete Care

 

1-800-424-4524 

https://www.molinahealthcare.com/providers/va/medicaid/home.aspx

 

Sentara Community Plan

1-800-881-2166 https://www.sentarahealthplans.com/providers

 

United Healthcare 

www.uhcprovider.com/

1-844-284-0149

 

Dental Provider

DentaQuest

1-888-912-3456