For Providers

It is important that providers verify the eligibility status of their Medicaid members each time services are rendered.  When a member’s circumstances change, they may also have changes to their eligibility status, program type or managed care organization (MCO) enrollment.  It is in your best interest to review members’ eligibility card each time you provide care.  Keep in mind that the possession of a card does not necessarily mean the holder is currently eligible for benefits, as members do not relinquish cards when coverage is cancelled.  With the potential for multiple cards, your best option is to verify members’ eligibility in one of two ways: 

1. Verify the member’s eligibility by using the MediCall automated phone system at  1-800-884-9730, or 804-965-9732.
2. Verify the member’s eligibility through the Virginia Medicaid web portal (MES).  From this page, click the blue login button, use your secure credentials to sign in, select PRSS Portal, and then access the Eligibility tab.

Providers can also verify a member’s eligibility without the Virginia Medicaid identification card using two other identification keys, such as full name, Social Security Number, and date of birth.

For additional resources for providers, visit the MES Provider Resources web page.

For assistance with billing, claims, member eligibility, memos and other regulations, call the Virginia Medicaid Provider Helpline at the toll-free (800-552-8627) or in-state (804-786-6273) phone numbers.  The Provider Helpline is available Monday to Friday between 8am and 5pm

For provider enrollment inquiries, contact the Virginia Medicaid Provider Enrollment Helpdesk by phone at 804-270-5105 or 888-829-5373.

Visit the Rate Setting page to navigate between specific rate types, as well as to find CPT and HCPC Procedure Codes and Managed Care Capitation information.