Virginia Premier Health Plan, Inc.

Network Development FAQs

Q: If a member requires a referral to a specialist how long is the referral good for?
Referrals are not required for a participating specialist. An authorization is required for non-participating Providers.

Q: Can we perform labs in our office?  If not which reference lab do VPHP members need to utilize?
You may perform specific CLIA waived labs for VPHP members in the office. All other lab tests must be sent to LABCORP or Carilion Consolidated Labs (CCL). A CLIA waive listing is located under the Provider Notice section of the website.

Q: I am not sure who my VPHP Provider Service Representative is, how can I find out who s/he is?
You can contact the Provider Services at 800-727-7536 option 6 for the name and number of your Provider Services Representative.

Q: Do VPHP members need referrals for routine vision services?
No.  Members may see a VSP contracted Provider without a referral for routine vision services.  For a list of participating providers go to www.vsp.com. or call (800) 852-7600.

Q: If a member presents for a visit with another PCP name on the card can we still see that member?
Yes. If you are a participating Provider with VPHP and you will continue to see member as their PCP, you may see that member, however, you should urge the member to call VPHP to change their PCP.

Q: Is transportation available to all VPHP enrolled members?
No. Routine transportation is not a covered benefit for FAMIS members. Transportation requests must be received 72 hours prior to the member’s appointment.

Q: What is the process for a member to change PCP?
The member should contact VPHP Member Services Department at (800) 727-7536 to change PCP.

Q: How long does the provider credentialing process takes with VPHP?
The credentialing process for Providers takes up to 180 days.

Q: Who should I contact to become a participating provider with VPHP?
Providers should complete and fax a “Recruitment Request Form” located under the Provider Service/Forms section of this website or you can contact the Provider Services at (800) 727-7536 option 6.

Q: I am leaving a practice to open a solo practice.  Do I need to sign a new contract with VPHP?
Yes. If you are opening a solo practice, you are required to give VPHP Network Development ninety (90) days advance written notice. The notice should be sent to Network Development at P.O. Box 5307, Richmond, VA 23220-0307 or fax to (804) 819-5366; ATTN: Contracting Specialist. The notification must include the effective date of new location, termination date with the other Group (if applicable), new physical location, remittance address, NPI number, phone number, fax number, email address and a copy of a W-9. Changes will not occur until a contract is returned to VPHP for execution.

Q: Is a provider required to notify VPHP when s/he is leaving a practice?
No. The Group is required to give VPHP ninety (90) days advance written notice with termination date and reason for Provider departure. The notice should be sent to Network Development at P.O. Box 5307, Richmond, VA 23220 or fax to (804) 819-5366; ATTN: Contracting Specialist. Note: If the Provider is a PCP, the notice should inform us where to reassign members.

Q: Is a solo practitioner/group required to notify VPHP when closing a practice?
Yes. The solo Practitioner/Group is required to give VPHP ninety (90) days advance written notice and thirty (30) days advance written notice to members. The solo Practitioner/Group should contact Network Development in writing to facilitate the transfer of members and arrange for Medical Management (Case Management) to work with solo Practitioner/Group to transition members to another Network Provider. The notice should be sent to Network Development at P.O. Box 5307, Richmond, VA 23220-0307 or fax to (804) 819-5366; ATTN: Contracting Specialist. The notification must include the following: effective date of closure, reason for closure, contact person, phone number, email address for follow-up questions, and information pertaining to accessing member’s medical records in the event they are needed by VPHP or for coordination of care for the member.

Q: How can I obtain a copy of the provider access standards for VPHP?
The access standards are located in the Provider Manual at www.virginiapremier.com. They are also posted annually in the Provider newsletter as well.

Q: Who do I contact to request an in-service for my office staff?
You can contact the Provider Services at 800-727-7536 option 6 and you will be provided with the name and number of your Provider Services Representative.

Q: Will Virginia Premier accept a DME request written on a prescription pad?
No. Pursuant to Centers for Medicare & Medicaid Services (CMS) all DME requests for supplies and equipment must be submitted on a certificate of medical necessity form (CMN) form for documentation purposes.    

Q: How often are fee schedules updated?
VPHP fee schedules are based on Department of Medical Assistance Services (DMAS) fee schedules. Schedules are updated annually or as changes are sent from DMAS.

Q: How can I obtain a Provider Manual? And how often are they updated?
Provider Manual is located and can be downloaded at www.virginiapremier.com. Hardcopies are available by contacting Network Development, (800) 727-7536 option 6. Manuals are updated as the needed. If there are any relevant changes they are posted on the website, quarterly Provider newsletters and special notices sent to Providers.

Q: Who should I contact if I suspect fraud?
If you suspect fraud being committed by a Member or Provider, please contact our Corporate Compliance Officer, Office of Privacy and Compliance at (800) 727-7536 ext. 5173. You can remain anonymous and information will be kept confidential.