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Claims and Billing for Fee-for-Service Members

Delayed Remittance Scheduled for June 28, 2024

The Appropriation Act requires that the remittance that normally would be paid on Friday, June 28, 2024 will instead be paid on Friday, July 5, 2024. 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 will be able to verify claims status information without disruption.  Providers should plan accordingly and prepare for this delay in claims payment. DMAS will not issue advance pays associated with this delay.

Therefore, all payments must be approved in the system prior to June 14th to be included in the final remittance on June 21th.

The information provided on this page is for Fee For Service (FFS) claims and billing only. View Cardinal Care Managed Care Claims and Billing information.

Providers who have received a claim (payment) denial from DMAS may wish to submit a new claim that includes corrections on the claim instead of filing an appeal. If you are unclear about why the claim was denied, DMAS encourages you to contact the Provider Helpline at (800) 552-8627 before deciding whether to file an appeal. If an appeal is filed, it will only address the denial reason(s) set forth on the remittance advice. Filling an appeal does not correct the denial reason(s) nor does an appeal involve reprocessing claims. If you are seeking to correct your claim, do so and resubmit your claim with the claim corrections for payment rather than filing an appeal.

Resubmitted claims will be processed as quickly as possible within 30 days or less. If another denial occurs, that remittance advice will carry have the claim denials (edits) that will need to be resolved and rebilled. If needed, each claim will have new appeal rights with DMAS.

As a reminder, always check a member’s eligibility before any Medicaid services begin. The instructions on this page are for FFS Members only. Please bill the Cardinal Care Managed Care program in which the member is enrolled.

Please call the Provider Helpline. The Provider Helpline is available Monday through Friday from 8:30 a.m. to 4:30 p.m., except state holidays, to answer questions. Please call (804) 786-6273 or 1-800-552-8627 (toll-free) for assistance.

There are three options to check the eligibility or claim status for a member:

  1. Use self-help service on the MES website. You can create an account if you don't have one by following the instructions on the page.
  2. Use the Virginia Medical Assistance MediCall System. (Learn how to use MediCall.) The MediCall System offers Medicaid providers 24/7 access to current member eligibility information, check status, claims status, prior authorization information, service limit information, pharmacy prescriber identification number cross reference, and information to access member eligibility and provider payment verification.
    The telephone numbers are: 
    • 1-800-772-9996 Toll-free throughout the United States 
    • 1-800-884-9730 Toll-free throughout the United States 
    • (804) 965-9732 Richmond and surrounding counties 
    • (804) 965-9733 Richmond and surrounding counties 
  3. For assistance with MediCall or other billing questions, call the Provider Helpline at (800) 552-8627.

Third Party Liability Information (TPL)

TPL is defined as any individual, entity, or program that is, or may be, liable to pay all or part of the medical cost of any medical assistance furnished to a recipient under the approved State Plan. Third parties include, but are not limited to:

  • Temporary Detention Order/Emergency Custody Order and FFS – Program Guideline Training
  • Private health insurance
  • Employment-related health insurance
  • Medical support from absent parents
  • Automobile insurance (including no-fault insurance)
  • Court judgments or settlements from a liability insurer
  • State workers’ compensation
  • First party probate-estate recoveries
  • Other Federal programs (unless excluded by statute; (i.e., Indian Health, Community Health, and Migrant Health programs).

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