Virginia Premier Health Plan

Virginia Premier Health Plan, Inc. is a Health Maintenance Organization, and a full service Medicaid HMO.

Latest News

Effective January 1, 2012, Some CPT and HCPC codes will not require a prior authorization when rendered by a Virginia Premier participating provider. The impacted codes include:

A9539
14000

Effective November 1, 2011, Virginia Premier will implement a precertification program for outpatient diagnostic imaging procedures utilizing National Imaging Associates, Inc. (NIA), http://www1.radmd.com/. Click here for more information on this change.

Prior authorization will be required for the following outpatient radiology procedures:

CT/CTA/CCTA
MRI/MRA
PET Scan
Nuclear Cardiology

Providers and their staff are encouraged to attend one of NIA’s webinars to learn more about this transition. To sign up for one of the NIA webinars please click here to download and print the webinar registration form and select a date and time to attend.

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NaviNet for Virginia Premier Health Plan is getting better!

Effective Friday September 2nd, you will see the following changes in NaviNet for Virginia Premier.

The names of the transactions have changed:

Auth/Admission Submission is now Inpatient Authorization Submission
Referral/Outpatient Submission is now Outpatient Authorization Submission
Referral/Authorization Inquiry is now Authorization Inquiry

How do these changes affect you?

There will be less restrictions when searching for providers and facilities making it easier to enter authorization requests
There will be improved searching capabilities for faster processing
There wll be fewer required fields to fill in
Authorization history will be opened up to allow providers to see all auth history

Self Disclosure of Overpayments: A Requirement Under the Affordable Care Act Section 6402(d)

Any provider of services or supplier who receives a payment under Medicare or Medicaid to which the person or entity, after applicable reconciliation, is not entitled, must return the funds within 60 days. The 60-day time limit begins from the time the provider/supplier identifies the overpayment OR when the overpayment is brought to the attention of the provider/supplier by Virginia Premier Health Plan.

Failure to report overpayments within the 60-day time requirement constitutes an obligation under the False Claims Act and could create a FCA liability.

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Virginia Premier Health Plan, Inc. is pleased to announce the addition of our Provider Resource Training Tool to the Virginia Premier website. This tool is used to answer general questions a Provider may have in regards to the different departments within VA Premier. It is our goal to have pertinent information readily accessible for our Providers. The Provider Resource Training Tool can be easily accessed by going to the Provider Services tab within the Virginia Premier website.

Virginia Premier Health Plan, Inc. has received excellence Awards from the National Committee for Quality Assurance (NCQA) for:

In 2011, VPHP achieved "Excellent" Accreditation Status from the National Committee for Quality Assurance (NCQA). It is the "Top Ranked" Medicaid Health Plan in Virginia and is ranked 26th in the Nation.
Innovative Efforts to Reduce Health Care Disparities for African American Women

Mission Statement

Virginia Premier Health Plan, a managed care organization partnered with Virginia Commonwealth University Health System, meets the needs of underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable healthcare.

Learn more about us »

Virginia Premier Health Plan, Inc.