Virginia Premier Health Plan, Inc.

Medical FAQs

Q: How can I get a hard copy of the forms and/or guidelines on the website?
Providers may contact Virginia Premier's Provider Services Department at (800) 727-7536.

Q: Do staff and providers receive incentives to decrease utilization?
No, Virginia Premier staff, practitioners or providers do not receive incentives to decrease utilization or withhold care.

Q: How can I get a copy of the criteria used to make medical necessity determinations?
Practitioners, providers and members may request a copy of the criteria used to make a medical necessity determination by contacting Virginia Premier's Medical Management department at (800) 727-7536. In addition, the full set of criteria are available for review at Virginia Premier, 600 East Broad Street, Suite 400, Richmond, VA 23219.

Q: Do members need a referral to see a specialist?
Members do not need a referral to see an in-network provider.  PCP's must obtain authorization from Virginia Premier prior to sending a member to an out of network provider.

Q: Can providers bill members?
You may not bill members for Medicaid covered services.

Q: How often are providers recredentialed?
Within three years.

Q: How can I refer a member to Va. Premier's Case Management, Disease Management or Health Education programs?
You may contact the Medical Management department by phone at (800) 727-7536 or enter the information on a referral form and fax it to the appropriate office location listed on the back of the referral form.

Q: Do I need to send in the OB registration when these services do not require a referral for payment?
Even though you are not paid from the OB registration, this form is critical to the early identification of Virginia Premier's case management and outreach programs to assist the member to make healthy choices throughout their pregnancy.

Q: How can I provide input into the changes in medical and pharmaceutical policies for Virginia Premier?
Virginia Premier has several practitioner committees that consist of your peers. In addition, you may contact the Senior Medical Director at (804) 819-5151 to provide your comments/suggestions or fax to (804) 819-5186 Attn: Senior Medical Director.

Q: How can I appeal a denial of a medical request for services?
You may submit your appeal in writing to:
Virginia Premier Health Plan, Inc.
Attention: Appeals
PO Box 5244
Richmond, Va. 23220-0244