Virginia Medicaid Web Portal

New Health Coverage for Adults

Beginning January 1, 2019, more adults living in Virginia will have access to
quality low-cost health coverage.

For more information, click here

Welcome

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Web Announcement Message

Claims Reprocess Notice

All claims that have been submitted and denied for a COVID procedure code that was billed as primary without a COVID diagnosis will be systematically reprocessed.

Web Portal and Security Changes

To access information about our Changes to the Provider Portal-Electronic Funds Transfer, Primary Account Holder, and web portal user status click here.

To enhance your self-service experience we have updated our user guides, click here to access our updated Provider Resources.

Provider Portal Updated Message

The provider portal maintenance functionality has been re-engaged.

If you have not logged on the portal within the last 90 days, please contact your Primary Account Holder (PAH) or Organization Administrator (OrgAdmin) to assist you with updating your account. If you are the PAH or OrgAdmin and are experiencing issues, please contact the Web Support Helpline at 866-352-0496.

Thank you for your patience while this work was in progress.

Nursing Facility Survey & FRV Reporting Form

Both the Nursing Facility Wage Survey and the Calendar Year (CY) 2019 Fair Rental Value Reporting Form have been posted on the Nursing Facility Website http://www.dmas.virginia.gov/#/nursingfacilities

The Nursing Facility Wage Survey is posted under the Wage Survey Ribbon at the top right. Participation in the Wage Survey is mandatory for all free-standing nursing facilities participating in Medicaid and/or Medicaid Managed Care Programs and is due February 21, 2020. Go to http://www.virginiamedicaid.dmas.virginia.gov/wps/portal/nfwagesurveyapplication to register and complete the Nursing Facility Wage Survey. Please email Sara.Benoit@dmas.virginia.gov with any questions.

The CY 2019 FRV Reporting Form is posted under the Reporting and Information ribbon at the top left. The CY 2019 FRV Reporting Form will be used to set Nursing Facility Capital Rates effective 7/1/2020. The CY 2019 FRV Reporting Form along with supporting documentation should be completed and returned to Myers & Stauffer LC through eDocMgmt by February 28, 2020. Please call Myers and Stauffer LC at (804) 270-2200 if you have any questions.

Important Information for Hospitals and Nursing Facilities on the new Virginia Cost Reporting System (VACRS) planned for release on December 1, 2019:

VACRS - Phase I Outreach - Hospitals

VACRS - Phase I Outreach - Nursing Facilities

Delayed Remittance Scheduled for June 28, 2019

The 2014 Appropriation Act requires that the remittance that normally would be paid on Friday, June 28, 2019 will be paid on Friday, July 5,2019. All claims will be processed as usual based on the date they are received. Furthermore, providers will be able to verify claims status information via Medicall and ARS without disruption. Providers should plan accordingly and prepare for this delay in claims payment. DMAS will not issue advance pays associated with this delay.

Memo Retraction: Removal of Exemption for Pregnant Women â€“ Effective 11/1/2018

The memo entitled, "Removal of Exemption for Pregnant Women to Opt Out of Managed Care in their Third Trimester in Commonwealth Coordinated Care (CCC) Plus and Medallion 4.0 Programs" has been retracted pending further review.

More information regarding updates are forthcoming.

Medicaid Portal Upgrade

On 12/01/18, an update will be made to the Medicaid portal that could negatively impact older browsers and/or older versions of Java.

The minimum version required for IE will need to be 11 and minimum Java version will be 8. If you need help in determining your current version of IE or Java, please click here

Inpatient Co-Payment Reduction

Hospitals should be made aware that, effective with dates of service on or after December 15, 2017, DMAS is reducing the cost sharing amounts for which facilities are liable for inpatient stays from $100 to $75. This change is required pursuant to federal changes in 42 CFR 447.52(b)(2) regarding maximum allowable cost sharing.

Attention All Providers of the Elderly or Disabled with Consumer Direction (EDCD) Waiver, and Tech Assisted (Tech) Waiver Services.

Virginia received approval from the Centers for Medicare and Medicaid Services (CMS) to combine the Elderly or Disabled with Consumer Direction (EDCD) Waiver with the Technology Assisted (Tech) Waiver, to be effective 7/1/2017. The new waiver is named the Commonwealth Coordinated Care Plus (CCC Plus) Waiver. Individuals served through the EDCD and Tech Waivers will automatically continue services through the CCC Plus Waiver. All service authorizations for the EDCD and Tech Waivers will continue; providers do not need to take any additional actions at this time. The effective date of the CCC Plus Waiver is July 1, 2017 and should not be confused with the implementation of the Commonwealth Coordinated Care Plus (CCC Plus) managed care program effective August 1, 2017. Please refer to the DMAS Provider Memo, dated 6/6/2017, Launch of Commonwealth Coordinated Care (CCC) Plus Waiver - Effective July 1, 2017 for additional details. This is available from DMAS at: https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/MedicaidMemostoProviders
For more information contact the DMAS Helpline at 1-800-552-8627 or 804-786-6273.

To all Medicaid Providers: Provider Appeal Request form now available

There is now a form available on the DMAS website to assist providers in filing an appeal with the DMAS Appeals Division. The link to the page is http://www.dmas.virginia.gov/#/appealsresources and the form can be accessed from there by clicking on "Click here to download a Provider Appeal Request Form." The form is in PDF format and has fillable fields. It can either be filled out online and then printed or downloaded and saved to your business computer. It is designed to save you time and money by assisting you in supplying all of the necessary information to identify your area of concern and the basic facts associated with that concern. Once you complete the form, you can simply print it and attach any supporting documentation you wish to, and send to the Appeals Division in the traditional manner.

PLAN FIRST

DMAS would like to remind providers of the benefits available through Virginia's Plan First program services. The availability of family planning services allows individuals to achieve desired birth spacing and family size and contributes to improved health outcomes for infants, children and families. The following link will show you the covered services for the program:

http://www.dmas.virginia.gov/#/planfirst

If you have any questions please email PlanFirst@dmas.virginia.gov

Appeals Division Fax Number Change

Be advised that the DMAS Appeals Division fax number has changed. Effective September 1, 2017, the old Appeals Division fax number will no longer function, and faxes sent to the old number will not be received by the Appeals Division. The new fax number is (804) 452-5454. Please verify that the Appeals Division fax number currently programmed into your fax machine or computer and the fax number in any document sent to any client is the new Appeals Division fax number prior to the deadline.

http://www.dmas.virginia.gov/#/appealsresources

Continuous Glucose Monitoring

Effective December 15, 2016, DMAS will CLARIFY THAT MEDICAID FEE-FOR-SERVICE COVERAGE of Continuous Glucose Monitoring (CGM) INCLUDES reimbursement for the sensor, transmitter, and receiver used with the invasive monitor. This equipment will be supplied by a Medicaid Durable Medical Equipment (DME) provider and billed as a DME item. Codes to be billed for the DME equipment are:
1) A9276 (CGM Sensor, invasive),
2)A9277 (CGM Transmitter; external) and
3) A9278 (CGM Receiver (monitor); external)
The CGM equipment requires service authorization. Providers will fax their requests on the Continuous Glucose Monitoring DME Request Form to the DMAS Medical Support Unit at 804-452-5450. The fax request form is available on the DMAS web portal in the Provider Services section. Refer to the DMAS Provider Memo, dated 11/2/2016, Clarification of Existing Medicaid Coverage of Continuous Glucose Monitoring (CGM) for members in Medicaid/FAMIS/FAMIS Fee-for-Service Programs-Effective for dates of service on or after December 15, 2016. This is available from DMAS at: https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/MedicaidMemostoProviders.

WebEx Training Sessions

If you would like to view training sessions on various topics related to Medicaid, please go to dmas.webex.com and select Recorded Sessions on the left panel.

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