MCO Provider Network news and resources...

Important Information for Managed Care Network Providers

The Federal law known as the 21st Century Cures Act requires all providers to enroll and periodically revalidate directly with DMAS through its provider services solution (PRSS) portal.  This requirement includes billing, servicing, ordering, referring, or prescribing (ORP) providers who serve members through managed care organizations (MCOs) or Fee-For-Service (FFS), or both. Dentists do not need to enroll in PRSS and should continue to enroll with the DMAS Dental Benefits Administrator, DentaQuest. For more information, contact DentaQuest Recruitment: 855-873-1283 or email NetworkDevelopment@dentaquest.com.

Provider Revalidations are In Progress!

Providers should receive a DMAS notice to begin their revalidation applications at least 90 days before the end of their enrollment period.  The notice is sent via email or U.S. Mail depending on the provider's communications preferences recorded in the PRSS provider portal.  Reminder notices are also sent at 60 and 30 days prior to the revalidation deadline.  Notification letters are sent via email from: appshcproductNoReply@gainwelltechnologies.com.  Providers are encouraged to add this email to their contacts so that they are not incorrectly marked as spam.  DMAS encourages providers to begin the revalidation application upon receipt of the notification to allow for sufficient processing time and time to make any needed corrections prior to the expiration date.  Providers can access their revalidation date in the provider portal or using the provider extract at the link in Step 3 below.

We have new FAQs to help Providers with this process.  

If you determine that your revalidation application requires corrections to the date of birth or SSNs,  special steps to correct this information will need to be followed to ensure data security and integrity.  Missing DOB and/or SSN on the PRSS Portal has been an issue for a few “Individual within a Group (IG) Revalidations.”  Please check your IG’s that are affiliated to ensure that DOB and SSNs are correct/present.  If you find it missing or incorrect, we can help!  Please fax a request on your company letter head (also have an owner or managing employee who is listed in the Group’s Portal sign the request) to update the information to PRSS at 804-270-7027.  You must include the following information:

• Groups NPI and Organization Name.
• Revalidation ATN (if already created), NPI for the IG’s, Name of the IG, and missing data points.
• Multiple provider changes can be submitted on each request submitted.

If the Revalidation is already in progress (ATN sent), the PRSS team will adjust your revalidation date out 180 days to get a new ATN created once the missing data is updated.  Sending this data in at least 90 days before the revalidation due date will reduce the risk of provider terminations.

MCO Network Provider Enrollment

PRSS remains open for providers required to enroll and who have not applied. Virginia Medicaid MCOs are prohibited from contracting with providers who are not enrolled in PRSS.  Providers who have received termination letters will not have their network participation status reinstated with the MCOs until they enroll/revalidate as requested in PRSS.

Three Action Items for Providers:

1.   Enroll/Revalidate in PRSS

We value your participation!  If you have not enrolled or have received notice to revalidate in PRSS, please visit virginia.hppcloud.com to initiate this mandatory enrollment/revalidation process now.  

Providers with multiple National Provider Identifier (NPI) numbers must enroll/revalidate all of their NPIs in PRSS.  Providers with multiple service locations must enroll/revalidate all locations.

2.   Contract with the MCO

In order to be a Medicaid provider in an MCO's network, providers must 1) enroll through PRSS and 2) contact the MCO(s) you wish to participate in to ensure each MCO’s requirements are satisfied.   If you have questions regarding how to submit your application to the MCO or your MCO participation (PAR) status, including your MCO PAR status reflected in PRSS, contact the MCO using the information in the table below.

3.   Check your enrollment status

All providers should check the Provider Extract spreadsheet (link below), which lists all active, enrolled Virginia Medicaid providers, revalidation dates and zip codes for related service locations.  Providers can download the file and use the spreadsheet to see if all of their NPIs and service locations are enrolled:

Download Latest Provider Extract Spreadsheet

(Note: This file can be opened with Microsoft Excel version 2007 or later and is updated at the beginning of each work week).  Dental providers will not be listed in the extract. Dental providers should enroll directly with DentaQuest, see contact information in the table below.  Click here for more information about this type of Excel file.

Action Item: If any of the provider’s NPIs or service locations are missing, the provider must enroll the missing NPI or service locations using the PRSS portal (see above).

If you need assistance or have questions...

If you have questions about the content in the provider extract spreadsheet file (link above), your NPI(s), revalidation dates or about the Virginia Medicaid Provider enrollment/revalidation process?  Please contact DMAS' PRSS vendor, Gainwell, at 1-888-829-5373, or by email:  vamedicaidproviderenrollment@gainwelltechnologies.com

If you have questions regarding your MCO participation (PAR) status, including your MCO PAR status reflected in PRSS, contact the MCO using the information in the table below. 

Important Links

• PRSS Enrollment and Instructions for this mandatory process:  virginia.hppcloud.com
• Helpful training resources available on the MES website:  vamedicaid.dmas.virginia.gov/training/providers

MCO Toolkit (Updated February 2023)

Download the MCO Toolkit (PDF)

Guidance for EI FQHC RHC CSB ORP and OOS Providers (MCO Only)

Guidance for EI FQHC RHC CSB ORP and OOS Providers (PDF)