Here doctors, nurses, and other health care providers who have patients enrolled in Virginia Premier Elite Plus. Here you’ll find forms, contact information and other resources.

Provider Resources

Our Provider Portal is a way for you to access resources online. Type in your username and password, and – wherever you are – Virginia Premier is with you. Don’t have a username and password yet? Click the link, and we’ll show you how to register. To register as a provider with DMAS, please see the Virginia Medicaid Web Portal for further instructions. You can find forms and instructions in the Provider Forms Library – for instance, for prior authorizations – that you need in order to provide care for your patients. If you need to contact Utilization Management, reach us at:

Phone: 1-888-251-3063 option 4 (TTY: 711)

Our Provider Manual will tell you all about Virginia Premier: your rights and responsibilities as a provider, important contact information and more. You can also read Provider Newsletters to get news, health tips, and other information.

Benefit and Authorization Overview

Click here to view Virginia Premier Elite Plus Summary of Benefits and Formulary Benefits. Together, they list the medical services and prescription medications (drugs) Virginia Premier covers. Requests for authorizations of member benefits are coordinated by our Utilization Management department and Long Term Support Service Coordinators. You can access and search our No Prior Authorization list by visiting our Utilization Management page here. If you have questions about how to request an authorization, please contact our Utilization Management team at 888-251-3063, press 4.

Claims

We are committed to providing you with the highest level of service possible in processing your claims. If you have questions for the Claims Department or suggestions on how we can improve our operations, please call us at 1-877-719-7358 (TTY: 711).

Electronic Claims Submission

Virginia Premier strongly encourages our providers to file their claims electronically. By filing claims electronically, you are able to benefit from shorter claims processing timeframes, which in turn allows Virginia Premier to make payments more quickly. The EDI 837 (Electronic Claims Enrollment) form can be found in the claims section of the Provider Forms Library. Our clearinghouse information is shown below and is also available in our Provider Manual.
Clearinghouse Phone E-mail Payer ID
Availity 1-800-282-4548 support@availity.com VPEP1
Change Healthcare 1-800-527-8133 rasupport@relayhealth.com Institutional – 1244 Professional – 4573

Direct Claims Submission

Virginia Premier also accepts direct claims submission for HCFA-1500 forms through our Portal. To register for the direct submission through our Portal, click here.

EDI 835 ERA

Should you want to receive the EDI 835 ERA (Electronic Remittance Advice) from Virginia Premier, the process is as simple as the process to send electronic claims to Virginia Premier. Only the form is different. The EDI 835 (Electronic Remittance Advice) form can be found in the claims section of the Provider Forms Library.

Paper Claims Submission

Virginia Premier Elite Plus will accept HCFA-1500 and UB-92 paper claims via the P.O. Box listed below:
Virginia Premier Elite Plus P.O. Box 4369 Richmond, VA 23220-8250

Requests for Reconsideration

Reconsiderations for denied claims must be sent within (60) days of the original date of denial. The Reconsideration form can be in the Provider Forms Library. Please send Requests for Reconsideration to:
Virginia Premier Elite Plus P.O. Box 4208 Richmond, VA 23220-8250
For questions, please call 1-877-719-7358 (TTY: 711); select option 9 for ARTS or option 2 for Claims.

Claim Status

Our Provider Portal is the easiest way to check claim status. Instructions are available within the portal. It will take about 3-5 business days to set up your account. You can also contact our Claims Customer Service team by calling 1-877-719-7358 (TTY: 711) and follow the prompts to reach Claims Customer Service.