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Virginia Medicaid Web Portal
Welcome   Skip portlet
Welcome to the Virginia Web Portal.
For log in or first time user registration, please go to the 'Login' section to the far right.
VARevalidationSchedule   Skip portlet
All Medicaid providers must be revalidated at least once every 5 years under the Affordable Care Act, Section 6401(a).

Click here to see if you are scheduled to receive next month's revalidation letter.
Virginia Medicaid Provider   Skip portlet

Your Opinion Counts!

We are seeking your participation in completing our latest bi-annual survey. The feedback obtained from this survey and prior surveys is used to assist us in making improvements in operations, services and support for our provider community. The entire survey will only take a few minutes. Your responses will be kept strictly confidential.

To complete the survey, please click here

Thank you in advance; your feedback is very valuable to us.

Web Announcements   Skip portlet
Change to the Service Authorization of Organ and Stem Cell Transplants and non-emergent, out-patient, out of state MRI, PET and CAT scans

Effective with request date of November 1, 2016, all physician requests of organ and bone marrow transplants and non-emergent, outpatient, out of state MRI, PET and CAT scans will be completed by the DMAS Medical Support Unit. Out of state is defined as any facility or provider not within the State of Virginia.
Providers who submit requests to KEPRO on or before October 31, 2016 will receive a final determination from KEPRO; providers are not to submit the same request to DMAS if the request was submitted to KEPRO.
This change only applies to members in the Medicaid and FAMIS Fee-for-Service programs and GAP. Members enrolled in Managed Care will follow the Prior Authorization process determined by the Managed Care plan. All requests as well as all pertinent medical information must be received at least 30 days prior to the date of the transplant procedure and/or diagnostic imaging. Providers will fax their requests to the DMAS Medicaid Support Unit, fax number 804-452-5450.

Hospitals will continue to submit to KEPRO their request for the in-patient hospitalization for the transplant. An approved physician authorization is required and must accompany the hospital request.
Please refer to the DMAS Provider Memo, dated 10/19/2016, Change to the Service Authorization of Organ and Stem Cell Transplants and non-emergent, out-patient, out of state MRI, PET and CAT scans - effective November 1, 2016 for additional details. This is available from DMAS at:

Medicaid Pharmacy Coverage of Insect Repellent - Effective August 22, 2016

Beginning August 22, 2016, Virginia Medicaid will cover certain insect repellent products as a Medicaid benefit for the prevention of Zika virus. This benefit is available to all Medicaid Fee-for-Service, FAMIS, FAMIS MOMS, Governors Access Plan (GAP) and Medicaid/FAMIS Managed Care members. The coverage is limited to members who are currently pregnant OR women and men of child bearing years (ages 14-44).

Providers can write a prescription for an "EPA-registered insect repellants" that can be called or faxed into pharmacies. A prescription is required. An office visit is not necessary solely to obtain a prescription. One can/bottle of repellent is permitted per prescription fill, with one refill allowed per calendar month.

For information related to the Medicaid/FAMIS Managed Care Plans' policies including the repellents covered by each plan, please go to and click on the link for Medicaid. Links to each of the plans' coverage and billing procedures can be accessed from this site. Detailed information can be found by accessing the DMAS website,, Virginia Medicaid Portal, Provider Services, Medicaid memos to Provider. The memo is titled
Medicaid Pharmacy Coverage of Insect Repellent - Effective August 22, 2016. A flyer is attached to the memo for posting in your office

Attention All Individual and Family Developmental Disabilities Support Waiver (DD Waiver) Case Managers:
Effective July 1, 2016, Keystone Peer Review Organization (KEPRO) will no longer process service authorization requests for DD Waiver services. All service authorization requests on or after July 1, 2016, must be submitted to the Department of Behavioral Health and Developmental Services (DBHDS). For more information contact the DBHDS Helpline at 804-663-7290 or access the DBHDS website:

Ambulatory Surgical Center and Outpatient Hospital Claim
This is to notify providers that Ambulatory Surgery Center (ASC) and Outpatient Hospital claims with dates of service on or after January 1, 2016 that were adjudicated prior to May 1, 2016 will be reprocessed the week of May 30, 2016 with a remittance date of June 10, 2016.

Delayed Remittance
The 2016 Appropriation Act requires that the remittance that normally would be paid on Friday, June 24, 2016 will instead be paid on Friday, July 1, 2016. This annual delay was originally communicated in our Medicaid Memo of May 14, 2010. All claims will be processed as usual based on the date they are received. Furthermore, providers should plan accordingly and prepare for this delay in claims payment. DMAS will not issue advance pays associated with this delay.

Patient Pay Reprocess
For providers submitting Crossover claims incorrectly subjected to patient pay deductions, DMAS will void and reprocess the identified claims.

For providers submitting claims that were subject to patient pay deductions and the incorrect deduction of the patient pay resulted in claims processing with a smaller patient pay amount being deducted for NF, waiver or other LTC services, DMAS will void and reprocess the identified claims.

All corrected claims will show on the remittance dated April 22, 2016. Providers are responsible for reviewing the remittance advice associated with the patient pay reprocess.

For the List of top 10 commonly occurring X12 compliance issues, use the following URL:

Outpatient Emergency Room Claims Spanning 9/30/15-10/01/15 Dates of Service
DMAS is requiring providers billing only Outpatient emergency room and observation claims that span 9/30/15 - 10/01/15 to keep those charges on one claim and bill with the ICD-9 diagnosis code(s). These claims will suspend for review and be adjudicated by DMAS.

Effective with dates of service October 1, 2015, ICD-10 coding goes into effect. Our system is tested and ready to accept properly coded ICD-10 claims. In order to prevent a denial, claims with dates of service prior to the ICD-10 compliance date must be coded with ICD-9. Claims with dates of service on or after the compliance date must be coded with ICD-10. For those providers billing in-patient hospital charges, DMAS will be using the ICD-10 diagnoses for all UB claims with a discharge date on or after October 1, 2015. Claims must be coded with either ICD-9 or ICD-10 codes but not with both. For more information, please see the Medicaid Memo dated August 25, 2015. It can be found on the Virginia Medicaid Web Portal under the Provider Services tab. Please select Medicaid Memos and then select the Medicaid Memo dated August 25, 2015. DMAS will not be issuing advance payments due to lack of provider readiness.

NEW - Managed Long Term Services and Supports (MLTSS) Stakeholder Notice
Please read the following important announcement regarding Virginia's proposed managed long-term services and supports (MLTSS) initiatives. Consistent with Virginia General Assembly directives, over the next couple of years, the Department of Medical Assistance Services (DMAS) will transition the majority of the remaining Medicaid fee-for-service populations into coordinated and integrated managed care models. Additional information on DMAS proposed initiatives is available at the following link:

Online Enrollment Access

To enroll online you must be logged in as a registered provider. To register, please follow the instructions below.

How to register:

In the Login box click the Provider link. In the First Time User Registration box click the Web Registration link. Enter the requested information and click Continue.
After you are registered and logged into the web portal, click on the Provider Enrollment tab to proceed to the online enrollment applications.

WebEx Training Sessions

If you would like to view training sessions on various topics related to Medicaid, please go to and select Recorded Sessions on the left panel.
Quick Links   Skip portlet
Sign In   Skip portlet
Log in to the system or register by selecting your role below: