Is there a place I can go to see if there are technical issues with MES or upcoming maintenance on the system?

Yes, the MES System Status page displays notices concerning planned outages, and the current known system status.

How do I access the VAMMIS portal we've been using for years?

The VAMMIS (legacy) portal has ceased operations permanently.  All users are required to access MMIS applications through the MES portal (Blue login button above).  MMIS functions are still available, and are accessed through the MES portal as well.

Which web browser can I use for MES and MMIS?

You can use any popular web browser to access MES, the Provider Portal (PRSS), and MMIS.

How will I receive my new MES credentials?

Once approved, you will receive two emails from donotreply@healthinteractive.net explaining the login process.  MMIS users will receive two additional emails, with User ID and temporary password specifically for MMIS.

Please see the  MES Provider training area for videos and user guides explaining the login process.  You can also  view a quick video explaining the process.

How will I access MMIS and the legacy VAMMIS portal?

All users must access MMIS by logging in to the MES secure portal (Blue button at the top of the page) and follow the MMIS link provided there.

How do we access training videos and learning resources?   Where can we find these, and is training free?

Free training courses and other information on the new system, are now available on the MES Public portal. The training area of the MES Public portal can be accessed here.   Look for the Provider Training course link on the right side of the page.

We do not know who our Primary Account Holder is, how do we find this information?

For privacy, security and control reasons, only your PAH can access this information.  Please contact the administrative lead or finance office for your organization to determine the PAH for your organization.

Providers who need to assign a primary account holder to their account at the tax identification number level must complete and submit a PAH Request form.  Please only submit one form.  Once the PAH is approved and receives credentials that person can assign delegate administrators and delegate users.

How long does it take to process the primary account holder (PAH) request form for provider portal access?

Please allow 7 to 10 business days for a response.  Ensure that you provide all requested information.  If the form is completed incorrectly, please allow 7 to 10 business days to review and approve the corrected submission.

I submitted a PAH form, but I did not receive a response. What should I do?

PRSS is actively reviewing requests for access.  Please allow 7 to 10 business days for a response.  Please do not submit another request.  PRSS will contact you if additional information is needed to grant access.

I need access to the provider portal to check eligibility and submit claims for my provider.  How do I obtain access?

If you have PRSS provider portal credentials, you may access these functions from the PRSS provider portal by logging in to MES (blue login button above).  If you do not have provider portal credentials, please contact the primary account holder (PAH) for your organization to grant you access as a delegate.  If you are the PAH for your organization and do not have credentials, please submit a PAH Request form to obtain provider portal credentials.

I did not receive my provider portal credentials, what can I do?

If you did not receive provider portal credentials and you are the designated primary account holder (PAH) for your organization, please submit a PAH Request form.  You can download from here.
If you have additional questions about the form or your portal account access please contact the PRSS help desk at 888-829-5373.

Will we need to set up all users (even those who aren’t delegated with administrative privileges) in the new MES Provider portal or will they be transferred over automatically?

Only the current, active primary account holders were transferred to the new system, all users (your Delegates for example) need to be set up.  The Primary Account Holder (PAH) must identify and authorize the delegate administrators and/or delegates in the provider portal account.   A great resource to help understand this process can be found on the Provider training page – look for the PRSS-118 Introduction to Provider and MCO Portal Delegate Management.

Do I need to have a Primary Account Holder for each tax ID for my organization?

Yes, Providers must have a Primary Account Holder for each tax ID associated with the provider.

Where can I find the new PAH request form?

The form can be downloaded using this link: PAH Request form

Who can I call with questions about who our PAH is, or if we need to complete a new PAH request form?

You can call the PRSS support number at 888-829-5373.  The PRSS team will be available to answer questions regarding provider portal credentials and delegates.

How do I request access to MES and the new PRSS provider portal?

For provider portal access, you must submit a new PAH update/change form.  The form can be downloaded from the MES Public portal.  The Primary Account Holder (PAH) must identify and authorize the delegate administrators and/or delegates in the provider portal account.  A great resource to help understand this process can be found on the Provider training page – look for the PRSS-118 Introduction to Provider and MCO Portal Delegate Management.

Physicians/Providers who have accounts that have been locked. Can we get our account unlocked?

For questions about portal accounts, please contact the PRSS support number at 888-829-5373.  

Our account was deactivated due to Inactivity.   How can we reactivate our account?

If your account has been deactivated due to inactivity, the primary account holder (PAH) for your organization will need to complete and submit a PAH Request form to have the account reactivated.   The PAH Request form can be downloaded here.

We have been asked to provide only a single email address for our organization’s Primary Account Holder (PAH), is this important?

Yes, all providers with active accounts must designate a single Primary Account Holder (PAH) for each tax identification entity.

Can Provider Organizations with more than one Tax ID use more than one Email Account?

Yes, although these organizations are allowed only one unique email per Tax ID number.

How often do I need to complete a revalidation?

In accordance with the ACA Provider Enrollment and Screening Regulations, all Virginia Medicaid Providers are required to revalidate their enrollment information at least every 5 years.

When can I revalidate?

You will receive notification 90 days prior to your contract’s expiration to revalidate your enrollment.  It is suggested you submit your revalidation as soon as you receive notification to allow for processing time and time to submit any corrections, if needed, prior to your contract’s expiration date.

How do I complete a revalidation application?

Navigate to: https://virginia.hppcloud.com/ to start or select via menu the option to resume/revalidate enrollment.  PRSS will send out a total of 4 letters for each Provider Location ID.

What correspondence will I receive regarding Revalidation?

90 Day Revalidation Notification
Notification contains the Application Tracking Number (ATN) with instructions to enter the ATN and password. 
Revalidation Password Notification – For security reasons the password and ATN are sent separately.
60 Day Revalidation Notification
Notification contains the ATN and will warn the provider that they have 60 days to revalidate their 14-digit Provider Location ID, or they risk termination in the VA FFS and MCO Programs.
30 Day Revalidation Notification
Notification contains the ATN and will warn the provider that they have 30 days to revalidate their 14-digit Provider Location ID and they risk termination in the VA FFS and MCO Programs.

How long will it take to hear back on my revalidation status?

The screening process can take up to 10 business days to process.  Additional screening requirements (Fee, Site Visit, and Background Check) may extend the handle time for the enrollment decision.

Why am I unable to access and submit my revalidation; the application status is expired?

If your revalidation is not submitted within 45 days of the service locations compliance due date for revalidation and termination, you will need to submit a new enrollment application and select yes to previously enrolled and indicate the service location ID for the service location terminated.  A Grace Period of up to 45 days is allowed on any provider revalidation that has not been submitted.  If the provider revalidation is returned to provider, the grace period is not allowed.  The provider will need to access and submit their application before the 30-day expiration requirements.

How can I determine my revalidation applications status?

Navigate to: https://virginia.hppcloud.com/ and select Enrollment Status. Enter your ATN and password that was entered when the enrollment application was started.  Note: To review your submitted application, click Print Preview to open a copy of the application in a new window to view, download, or print.

How can I change my enrollment details selected?

Depending on the change need the details entered can be edited using the edit icon.  The Enrollment Type and Provider Type selections, however, determine the information required throughout the application.  Depending on your selections, you may receive a message indicating your provider risk-level; limited, moderate, or high, which may modify your requirements for enrollment.  If the Enrollment and Provider Type needs to be updated, cancel the current partial enrollment and register to start a new enrollment application.

When do I select yes to Are you currently enrolled as a Provider?

If you are not revalidating, select No and continue as a new enrollment.  If you received your revalidation letters, select Yes then click Yes on the message window asking if you wish to revalidate your existing enrollment.  You will be redirected to the Resume/Revalidate page.

When do I select yes to Were you previously enrolled as a Provider?

Only select Yes if you were active in the Virginia Medicaid program, but no longer have active contracts and wish to apply for reenrollment.

When do I select yes to Are you Medicare Enrolled?

A yes response is used to trigger a fee waiver request for Medicaid participation as fees already paid to Medicare may be applied.  Additionally, it may be used for post-enrollment activities such as processing crossover claims.

Do I need to pay an application fee on my revalidation application?

Based on your selections, the Amount Due displays either No Fee or the amount due.  Note: If an enrollment application for the Virginia Medicaid program is received and deemed to require an application fee but one is not submitted or payment is not in an acceptable format, the entire application will be returned to the Provider requesting proper payment.  The Provider has 30 days to complete the payment and resubmit the application before the entire application will be denied.

What are my next steps if my revalidation is returned for corrections?

After submission, applications cannot be viewed or modified unless a PRSS Enrollment and Management Clerk returns it for corrections.  If your application is returned for corrections, you will receive a notification with changes that need to be made.  This includes providing an additional attachment or editing responses.  You have 30 days to make the corrections and resubmit your application: if not completed by the deadline, your applications status will update to expired and will not be accessible.

What if I do not submit by the revalidation compliance date?

If your revalidation is not submitted by the compliance date, the provider will have up to 45 days to submit the revalidation application as part of the revalidation grace period implementation.  Select the resume revalidation option as normal to complete the revalidation. Providers who submit the revalidation will not qualify for a grace period.

What are my next steps if my revalidation is denied?

You will receive a notification with reasons that your revalidation was denied. The provider will be terminated as of the revalidation compliance date if the revalidation application is denied.  If you are able to address the denial reasons by the compliance date, you may submit a re-enrollment application.

What are my next steps if my revalidation is approved?

If your revalidation is approved, you will receive notification of your approval and ongoing provider maintenance will conducted in Provider Portal.  Refer to the Virginia Provider Portal User Guide for functionally.

• If you selected to apply for any MCO program(s) in the General Information section of your application, your application and participation request is submitted to the MCO(s).
• Any allowed changes made via the revalidation will be applied to the associated service location.

For Waiver Providers - When will the procedure codes and taxonomy codes be available?

Please download the document titled “Waiver Services Taxonomy" from the Downloads page.  This document includes procedure codes based on provider types and specialties and associated taxonomy.   Lastly, it will assist Waiver providers with billing.

For CCC Plus Providers - When will the procedure codes and taxonomy codes be available?

Please download the document titled “CCC Plus Waiver Services Taxonomy Guide" from the Downloads page.  This document includes procedure codes based on provider types and specialties and associated taxonomy.   Lastly, it will assist Waiver providers with billing.

Will specific description/detail fields in the “new” electronic 1500 be available so that the various Electronic Health Record (EHR) and Clearing House vendors can make modifications to allow billing?

There are no "new" electronic fields.   However, the appropriate taxonomy must be submitted on the claim.  Providers should access the new Provider Portal (PRSS) to validate the taxonomy that is associated with their National Provider Identifier (NPI) and location.  Login to MES (blue button above) to access PRSS.

Will providers who do direct-entry billing, continue to use the existing templates (Roll Over)?

Existing templates will “rollover” for Direct Data Entry (DDE) so that providers will not have to set up new ones.   However, the taxonomy code must be updated if different from what was previously used.

Will a taxonomy code be assigned to Providers, or should we choose our own?

DMAS will assign a taxonomy code if the Provider does not provide one.  Providers must provide a valid taxonomy code for their services provided.   They can verify their taxonomy codes that are registered for their NPI(s) on the National Plan and Provider Enumeration System (NPPES) website.

How do I access and download a Remittance Advice (RA) from the provider portal?

RAs can be downloaded in PDF format, after logging into the new Provider portal (PRSS).  Login to MES (blue button above) to access PRSS.

The MES provider document download instructions can be found on the MES Provider training page.  Once there, look for the PRSS-121 course/user guide.  The user guide describes "Remittance Advice" in the Search Criteria.

I did not receive my paper remittance advice (RA).  How do I request a paper RA?

Fee-for-service providers will no longer receive paper remittance advices (RAs) for claims submitted after 8 p.m. March 25, 2022.  RAs are available for download in PDF format.

Remittance Advice Note (Hardship Request):

Providers may submit a hardship request to receive paper RAs by sending a signed letter on company letterhead to this address:  Virginia Medicaid Provider Enrollment Services, P.O. Box 26803, Richmond, VA 23261-6803.  You can also fax your letter to 1-888-335-8476.  The hardship request should include a reason for the request as well as any efforts the provider is taking to transition from printed to electronic remittances and a timeline for that process.

How do I request access to MES and the new PRSS provider portal?

For provider portal access, you must submit a new PAH update/change form.  The form can be downloaded from the MES Public portal, here.  The Primary Account Holder (PAH) must identify and authorize the delegate administrators and/or delegates in the provider portal account.  A great resource to help understand this process can be found on the Provider training page – look for the PRSS-118 Introduction to Provider and MCO Portal Delegate Management.

Are paper applications be accepted for new enrollments or updates?

No.   Paper applications are no longer accepted.

How do I enroll in PRSS as a hospitalist? 

Hospitalists are reimbursed under the hospital's billing.  Hospitalists who order, refer, or prescribe Medicaid services through fee-for-service or the MCO program should enroll in PRSS using the specialty that aligns with the hospitalist's licensure through the Virginia Department of Health Professions, or for out of state physicians, the licensing entity in the provider's home state.  Hospitalists also have the option of enrolling as an "MCO only provider" as a hospitalist provider type; however, this would not allow the hospitalist to order, refer, or prescribe services for fee-for-service members.

How do I complete a new enrollment application/request?

Navigate to the PE Home page: https://virginia.hppcloud.com/ to start/resume a new enrollment/revalidation.

How long will it take to hear back on my enrollment status?

Enrollment request can take up to 10 business days to process.  Additional screening requirements (Fee, Site Visit, and Background Check) may extend the handle time for the enrollment decision.

Do I need to complete the Pre-Enrollment Checklist?

Though generating a pre-checklist is optional, it is highly recommended to ensure that you have all documentation ready so that you are able to complete your application as easily and quickly as possible.  This step is particularly helpful if a delegate will be managing your application.  Note: Required credentials and attachments for specific Enrollment Type, Provider Type and Specialty combinations will be listed.

I am unable to access and submit my application; the application status is expired?

If your application is not submitted and is inactive for thirty (30) days, it will expire.  A courtesy reminder to submit your application is sent fifteen (15) days prior to expiration.  If your application expires, an application expiration notice will be sent to the email address entered during registration for the application and you will be required to start a new application to apply to the Virginia Medicaid program.

How can I determine my enrollment applications status?

Navigate to: https://virginia.hppcloud.com/ and select Enrollment Status.  Enter your ATN and password that was entered when the enrollment application was started.  Note: To review your submitted application, click Print Preview to open a copy of the application in a new window to view, download, or print.

How can I change my enrollment details selected?

Depending on the change need the details entered can be edited using the edit icon.  The Enrollment Type and Provider Type selections, however, determine the information required throughout the application.  Depending on your selections, you may receive a message indicating your provider risk-level, limited, moderate, or high, which may modify your requirements for enrollment.  If the Enrollment and Provider Type needs to be updated, cancel the current partial enrollment and register to start a new enrollment application.

When do I select yes to Are you currently enrolled as a Provider?

If you are not revalidating, select No and continue as a new enrollment.  If you received your revalidation letters, select Yes then click Yes on the message window asking if you wish to revalidate your existing enrollment.  You will be redirected to the Resume/Revalidate page.

When do I select Yes to where you previously enrolled as a Provider?

Only select Yes if you were active in the Virginia Medicaid program but no longer have active contracts and wish to apply for reenrollment.

When do I select yes to Are you Medicare Enrolled?

A yes response is used to trigger a fee waiver request for Medicaid participation as fees already paid to Medicare may be applied.  Additionally, it may be used for post-enrollment activities such as processing crossover claims.

Do I need to pay an application fee on my enrollment application?

Based on your selections, the Amount Due displays either No Fee or the amount due.  Note: If an enrollment application for the Virginia Medicaid program is received and deemed to require an application fee but one is not submitted or payment is not in an acceptable format, the entire application will be returned to the Provider requesting proper payment.  The Provider has 30 days to complete the payment and resubmit the application before the entire application will be denied.

What are my next steps if my application is returned for corrections?

After submission, applications cannot be viewed or modified unless a PRSS Enrollment and Management Clerk returns it for corrections.  If your application is returned for corrections, you will receive a notification with changes that need to be made.  This includes providing an additional attachment or editing responses.  You have 30 days to make the corrections and resubmit your application: if not completed by the deadline, your application will be denied.

What are my next steps if my application is denied?

You will receive a notification with reasons that your application was denied.  You are not enrolled in the Virginia Medicaid program.  If you are able to address the denial reasons, you may submit a new enrollment application.

What are my next steps if my application is approved?

If your application is approved, you will receive notification of your approval and ongoing provider maintenance will conducted in Provider Portal.  Refer to the Virginia Provider Portal User Guide for functionally.

• If you do not already have Provider Portal credentials for your NPI, you will receive two emails: one with your username and one with your password.
• If you already have Provider Portal credentials (i.e., you completed an application for a new Service Location) for your NPI, you will NOT receive additional credential information.  Instead, the new Service Location will be matched based on your NPI and both locations will display in Provider Portal.  If you need to assign delegates for the new location, complete the steps in Provider Portal as delegate access is not automatically applied.
• If you selected to apply for any MCO program(s) in the General Information section of your application, your application and participation request is submitted to the MCO(s).

When can I revalidate?

You will receive notification 90 days prior to your contract’s expiration to revalidate your enrollment.  It is suggested you submit your revalidation as soon as you receive notification to allow for processing time and time to submit any corrections, if needed, prior to your contract’s expiration date.

How can we determine Member eligibility?

You can call the help line at 800-932-6648.  Give the call center the Members Full Name, DOB, Gender and Race.  They will verify eligibility.

Are there switch fees applicable in the reversal and rebill? 

Yes

If we are unable to determine member eligibility and the pharmacy dispenses under good faith, then later it's determined that the patient didn't qualify - how can we recover the cost? 

DMAS will cover the risk and cost, there will NOT be any liability to the pharmacy.