The Department of Medical Assistance Services (DMAS) thanks you for your part in providing access to health services for 2 million Virginians. Whether you are a new or existing Virginia Medicaid provider, DMAS is here to assist you in finding information, training and resources about the Virginia Medicaid program with ease.
Find popular resources, answers to Frequently Asked Questions and a brief overview of each of the different Provider topic hubs available on our website below. Subscribe to receive email updates on the latest Virginia Medicaid news.
Hurricane Ian - Florida Medicaid Provisional Enrollment for Out-of-State Providers
For out-of-state providers, who are not enrolled with Florida Medicaid and who provided services to displaced Florida residents, Florida Medicaid has created a provisional provider enrollment process. Florida Medicaid has waived the requirements for providers to submit documentation showing the nature of the treatment, as well as other normally-required information, when applying for provisional enrollment.
For fee-for-service provisional enrollment, Florida Medicaid requires the following:
- A fully completed claim form containing the provider’s active National Provider Identifier (NPI), along with the provider’s SSN/FEIN;
- A signed Florida Medicaid Provider Agreement (MPA);
- A copy of the provider’s professional license; and
- An optional signed Florida Medicaid Electronic Funds Transfer (EFT) Authorization Agreement, if providers choose to receive payment electronically.
Managed care plans performing provisional enrollment can accept the same or similar items used by the plans when enrolling out-of-network providers.
Frequently Asked Questions
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.
Visit the Eligibility Guidance page for policies, procedures, communication bulletins and other information used to determine a person's eligibility for Medical Assistance programs in Virginia.
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.
For managed care assistance, call 800-643-2273 or email ManagedCareHelp@dmas.virginia.gov.
- Durable Medical Equipment (DME): View and download Appendix B files and access DME training.
- General Information: Find financial, billing, claims and outreach materials, including Hospital Presumptive Eligibility Information and the Medicaid Provider Manual Drafts.
- Medical Assistance Eligibility Manual: View and download chapters of the Eligibility Manual, which is used to determine a person's eligibility for Medicaid, Family Access to Medical Insurance Security Plan (FAMIS), children’s Medicaid and FAMIS Prenatal coverage. Search the contents of the Eligibility Manual.
- MES Provider Manuals Library
- MES Memo/Bulletin Library
- MES Provider Resources
- Procedure Fee Files & CPT Codes: Search CPT codes by service date, flag code or multiple CPT codes, and access other procedure fee files.
- Rate Setting: Find rate setting information for Medicaid reimbursement.
- Virginia Medicaid Portal FAQ: Find questions and answers for Providers leading up to the MES and PRSS portal launches on April 4, 2022.
For Providers - Navigate
Addiction and Recovery Treatment Services
The Addiction and Recovery Treatment Services (ARTS) benefit provides treatment for those with substance use disorders across the state.
Providing an array of behavioral health and addiction and recovery treatment services through Managed Care Organizations, CCC Plus and Medallion 4.0, and through the Behavioral Health Services Administrator.
Cardinal Care Transition
Learn about the transition to Cardinal Care, a unified managed care program that offers a clearer, straighter path to care for Medicaid members.
Virginia's Medicaid Smiles For Children program offers comprehensive dental services to children, through age 20.
Long Term Care
Nursing Facilities, Specialized Care Nursing Facilities, Long-Stay Hospitals, Home Health and more.
Information for Commonwealth Coordinated Care Plus (CCC Plus) and Medallion 4.0 Managed Care Programs.
Maternal and Child Health
Virginia’s Maternal and Child Health Insurance Programs, which include Family Access to Medical Insurance Security (FAMIS) and children's Medicaid.
Medicaid Enterprise System
Information about Virginia Medicaid's new technology platform launching in April 2022 as part of the Medicaid Enterprise System (MES) project, including the Provider Services Solution (PRSS) module.
Pharmacy and Drug Formularies
Reference site for the Preferred Drug List and Prior Authorization Programs, as well as for information on upcoming changes.
A program for eligible men and women that covers birth control and services to help prevent unplanned pregnancies.
Rates and Rate Setting
Department of Medical Assistance Services (DMAS) Rates and Rate Setting Information for Medicaid Reimbursement.
School Based Services
In some instances, schools can be reimbursed some of the costs associated with providing these services to children enrolled in Medicaid or FAMIS.