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Providers

Forms Library

Are you a Provider and looking for a specific Virginia Premier form or document? Find forms quickly in our Provider Forms Library by either searching by the type of file you need.

Claims and EDI Forms

Contracting and Credentialing Forms

  • Recruitment Request Form
    Are you a physician or healthcare provider interested in joining the Virginia Premier network? Please fill out Recruitment Request form to request participation in the Virginia Premier network.
  • Transportation Recruitment Request Form
    Complete this form when requesting a vendor to be recruited, or when receiving a call from an interested vendor.
  • Provider Update Request Form
    Are you already a participating provider for Virginia Premier and need to notify us for updates or changes to your office or provider information such as address, phone or providers? Please use this page to submit changes to Virginia Premier.
  • Panel Change Request Form
    Are you a participating PCP and would like to close or open your member panel? Please use this form to notify Virginia Premier of your request.
  • Organizational Enrollment Application Form
    Download our organizational enrollment packet and application.

Medical Management

Pharmacy Forms

Formulary

Medallion 3.0 and FAMIS Members