Updates to Department of Behavioral Health and Developmental Services (DBHDS) licensing of Multisystemic Therapy (MST) providers and DMAS Enrollment
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The purpose of this bulletin is to inform Multisystemic Therapy (MST) providers enrolled in the DMAS Provider Enrollment System with a provider type of 156 or 456 and provider specialty 922, of upcoming DBHDS licensing changes. DBHDS will transition all providers of MST services from the Intensive In-Home license (05-001) to the Mental Health Outpatient license (07-003) by March 31, 2026. These changes are outlined in a DBHDS memorandum available here. DMAS and the DMAS enrollment contractor will complete the work necessary to update DBHDS licenses for MST providers in the DMAS’ Provider Services Solution (PRSS). No provider action is necessary at this time. Provider participation requirements for Medicaid reimbursement of MST services require all MST providers to maintain both their license with DBHDS and an active program certification with MST Services Inc., as listed on Virginia’s Evidence-based Programs Finder (www.ebpfinder.org). Specific MST program and provider requirements are located in the Intensive Community Based Support – Youth Appendix (Appendix D) of the Mental Health Services Manual which is being updated to reflect the new March 31, 2026 DBHDS license requirement for MST providers. To avoid disruption to claims payment through FFS and the MCOs providers must periodically check the DMAS provider portal, also known as the Provider Services Solution (PRSS), to ensure that the provider's enrollment, contact information, and license information is up to date, for all of the provider's respective service locations. Under federal rules, MCOs and DMAS are prohibited from paying claims to network providers who are not enrolled in PRSS. Additional information is provided on the MCO Provider Network Resources webpage and includes links to resources, tutorials and contact information to reach Gainwell with any provider enrollment or revalidation related questions. Dental providers should continue to enroll directly through the DMAS Dental Benefits Administrator, DentaQuest. 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 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 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 1-800-901-0020 Humana Healthy Horizons Provider Services Call Center 1-844-881-4482 (TTY: 711) Sentara Community Plan 1-800-881-2166 https://www.sentarahealthplans.com/providers United Healthcare 1-844-284-0146 Acentra Health Behavioral Health and Medical Service Authorizations https://vamedicaid.dmas.virginia.gov/sa 1-804-622-8900 Dental Provider DentaQuest 1-888-912-3456 Fee-for-Service (POS) Prime Therapeutics https://www.virginiamedicaidpharmacyservices.com/ 1-800-932-6648
DMAS and the DMAS enrollment contractor will complete the work necessary to update DBHDS licenses for MST providers in the DMAS’ Provider Services Solution (PRSS). No provider action is necessary at this time.
Provider participation requirements for Medicaid reimbursement of MST services require all MST providers to maintain both their license with DBHDS and an active program certification with MST Services Inc., as listed on Virginia’s Evidence-based Programs Finder (www.ebpfinder.org). Specific MST program and provider requirements are located in the Intensive Community Based Support – Youth Appendix (Appendix D) of the Mental Health Services Manual which is being updated to reflect the new March 31, 2026 DBHDS license requirement for MST providers.
To avoid disruption to claims payment through FFS and the MCOs providers must periodically check the DMAS provider portal, also known as the Provider Services Solution (PRSS), to ensure that the provider's enrollment, contact information, and license information is up to date, for all of the provider's respective service locations. Under federal rules, MCOs and DMAS are prohibited from paying claims to network providers who are not enrolled in PRSS. Additional information is provided on the MCO Provider Network Resources webpage and includes links to resources, tutorials and contact information to reach Gainwell with any provider enrollment or revalidation related questions. Dental providers should continue to enroll directly through the DMAS Dental Benefits Administrator, DentaQuest.
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 |
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 | |
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 | 1-800-901-0020
|
Humana Healthy Horizons Provider Services Call Center | 1-844-881-4482 (TTY: 711) |
Sentara Community Plan | 1-800-881-2166 https://www.sentarahealthplans.com/providers
|
United Healthcare | 1-844-284-0146
|
Acentra Health Behavioral Health and Medical Service Authorizations | https://vamedicaid.dmas.virginia.gov/sa 1-804-622-8900 |
Dental Provider DentaQuest | 1-888-912-3456 |
Fee-for-Service (POS) Prime Therapeutics
| https://www.virginiamedicaidpharmacyservices.com/ 1-800-932-6648 |