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

  Provider Portal Updated Message

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 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.

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of Managed Care in their Third Trimester in Commonwealth Coordinated Care (CCC)  Plus and Medallion 4.0 Programs" has been retracted pending further review.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

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