We know that you are busy, and having access to the latest health care tools and information is critical in today’s fast paced healthcare environment. Virginia Premier Elite has created an area dedicated to providing quick and easy access to the latest provider communications and tools.
The Provider Manual is one of the many tools that Virginia Premier Elite has available to make doing business with us easier. The Provider Manuals contain Virginia Premier Elite’s policies and processes on topics such as Member Benefits and Covered Services, Claims and Electronic Payments, Medical Mangement, Pharmacy Guidelines and much more. Virginia Premier Provider Manual
Looking for the latest Virginia health care news and updates from Virginia Premier Elite? The Provider Newsletter is just one of the ways we regularly communicate changes, updates and reminders to the provider network.
We’re here for you! Virginia Premier Elite is building free online training modules and a library of literature to help give our providers the best possible resources to care for your patients.

Virginia Premier Elite Training

Annual Provider Training If you would like to attend an in-person training, our schedule can be found under the Education Meetings tab. If you are looking for our “Nuts and Bolts” training, look here. If you have any questions about our training options, please contact us.

Some of the training topics we offer are:

  • Cultural Competency
  • Practice Accessibility
  • Patient Safety
  • Disability Literacy
  • And many more great topics!
Looking for answers to your questions? Virginia Premier Elite has created a FAQ page with some of the most commonly asked questions from our providers.

Eligibility and Enrollment

Q: Who is eligible for Virginia Premier Elite?

Eligible individuals include those who:
  • Are 21 and older
  • Are enrolled in full Medicare and full Medicaid
  • Live in designated regions of Virginia serviced under Virginia Premier Elite

Q: How are members enrolled with a Virginia Premier Elite?

Persons seeking to enroll with Virginia Premier Elite must fill out an application that will be submitted to CMS for approval.

Q: Do I need to check member eligibility?

Each new member enrolled with Virginia Premier Elite will receive an individual member identification card. It is important to remember that a member’s eligibility could change on a month-to-month basis. Consequently, you should verify your patient’s eligibility each time they present for services. Providers can check member eligibility through several methods:
  • Call Virginia Premier Elite: 877-739-1370
  • Check member eligibility with the Virginia Premier Elite Provider Portal

Benefits and Covered Services

Q: What are the benefits for a potential enrollee to enroll with Virginia Premier Elite?

  • One ID card for members
  • One toll free phone number for 24 hours/7 days a week assistance
  • A unified appeals process
  • Person-centered service coordination/case management

Q: What are the covered services to members enrolled Virginia Premier Elite?

Benefits include all original Medicare (part A and part B) benefits and Part D benefits. Supplemental benefits include vision, dental, OTC, and hearing aid reimbursement.

Q: Are there guidelines regarding out-of-network referrals for Virginia Premier Elite members?

Referrals to non-participating specialists are permitted only if the required specialty service is not available through the Virginia Premier Health Plan network and the service is pre-authorized by the Plan. Out-of-plan referrals should be documented in the POC (Plan of Care) and agreed to by all ICT members.

Q: Can enrollees see providers who are out of network?

Yes, the plan must allow enrollees to maintain their current providers (including out-of-network providers) for 90 days from enrollment for new enrollees or for 30 days if the enrollee is switching from another MA plan. However, after that period the plan must authorize any request to see an out-of-network provider.

Billing and Claims

Do I need to submit a claim to both Virginia Premier and Medicaid in order to get paid?

No. Providers only need to submit claims directly to Virginia Premier Elite.

Do members enrolled in Virginia Premier Elite have co-pays or cost sharing?

No. As part of this program, there is no cost-sharing. Providers cannot collect co-payments, coinsurance, deductibles or any other amount for services covered under this plan. The contract you have with Virginia Premier Elite clearly stipulates that you cannot balance bill members enrolled with Virginia Premier Elite.

Are there are special requirements for how I bill services rendered to Virginia Premier Elite members?

No. Providers are expected to follow Medicare billing guidelines unless otherwise noted in the Virginia Premier Elite Provider Manual.

What is the timely filing period for participating Virginia Premier Elite providers?

Providers should follow the timely filing as indicated on their contract, but in general providers have 180 days to file claims to Virginia Premier Elite.

Grievances and Appeals

How do members appeal a decision made by the plan?

An enrollee or a provider acting on behalf of an Enrollee and with the Enrollee’s written consent may appeal the plan’s decision to deny, terminate, suspend, or reduce services. An enrollee or provider acting on behalf of an enrollee and with the enrollee’s consent may also appeal the plan’s delay in providing or arranging for a Covered Service. Virginia Premier Elite has 30 days from receipt to resolve all initial appeals and seventy-two (72) hours or as expeditiously as the enrollee’s condition requires for appeals qualifying as expedited appeals.

Provider Participation

I am a Virginia Premier Elite PCP. What are my responsibilities?

In addition to managing the members overall health and well-being you will:
  • Develop, maintain and monitor Plan of Care (POC) for the member
  • Actively participate as a member of the Interdisciplinary Care Team (ICT)
  • Perform an initial health assessment for new members assigned to their panel to begin establishing the physician-patient relationship
  • Direct provision or coordination of all healthcare services for the member to include 24-hour coverage
  • Generate referrals to in-network specialist when services cannot be performed by the PCP
  • Contact Virginia Premier Elite to obtain necessary prior authorization for designated services (e.g. out of network referrals, specified diagnostic tests)
  • Freely communicate with patients about their treatment, regardless of benefit coverage limitations
Interested in the opportunity to interact with your local Provider Services team and other providers in your area? Then attend one of Virginia Premier Elite’s quarterly Provider Education meetings that are held throughout our various service areas. These meetings are intended to give providers and their staff the opportunity to exchange ideas and suggestions with Virginia Premier Elite staff while also receiving the latest news and updates. Please RSVP to the contact provided under the location you wish to attend.

Regional Contacts

Central Virginia:

Nick Furnish at 800.727.7536 ext. 56008 or email: nicholas.furnish@vapremier.com
A.J. Binga at 800.727.7536 ext. 55263 or email: anthony.binga@vapremier.com
John Strube 880.727.7536 ext.56091 or email: john.strube@vapremier.com

Roanoke

Tammy English at 888.338.4579 ext. 55817 tenglish@vapremier.com
Rebecca Frango at 888.338.4579 ext. 55876 or email: rebecca.frango@vapremier.com
Katrina Evans at 888.338.4579 ext. 55883 or email: katrina.evans@vapremier.com

Tidewater

Rashard Grier at 888.828.7989 ext. 55501 or email: Rashard.grier@vapremier.com

Western Va

Roger Young at 540.607.7312 or email: ryoung@vapremier.com

South West Virginia

Robin Murray at 888.338.4579 ext. 55626 or email: rmurray@vapremier.com
Spencer Huddleston at 888.338.4579 ext. 55667 or email: rhuddleston@vapremier.com

Northern VA

Tanya Labrador at 804.998.0548 or email: tanya.labrador@vapremier.com
Jeanne Bellucci at 540.597.0283 or email: jeannebellucci1@vapremier.com