Virginia Medicaid Provider Phone Numbers & Contacts

Navigating healthcare systems can often feel like a maze, especially when you need to connect with specific providers or support. For beneficiaries and healthcare professionals alike, having the correct Virginia Medicaid Provider Phone Number is crucial for accessing services, addressing queries, and ensuring continuity of care. This comprehensive guide cuts through the complexity, offering direct contact details, strategic tips for effective communication, and insights into Virginia's Medicaid structure to help you connect effortlessly.

Understanding Virginia Medicaid Contact Channels

Virginia Medicaid is administered by the Department of Medical Assistance Services (DMAS) and primarily operates through Managed Care Organizations (MCOs), though some services remain under a Fee-for-Service (FFS) model. Knowing which channel to use for your specific needs is the first step toward efficient communication.

In our experience, having direct numbers can save significant time and frustration. Instead of generic helplines, connecting with the right department or MCO ensures your query reaches someone equipped to help.

Why Direct Contact Matters

Direct contact numbers streamline communication, reducing the need for multiple transfers and long hold times. For beneficiaries, this means quicker access to appointment scheduling, benefit explanations, and issue resolution. For providers, it facilitates faster claims processing, prior authorization requests, and administrative support.

When to Use Which Channel

• Managed Care Organizations (MCOs): If you are enrolled in a Virginia Medicaid MCO (e.g., Anthem, Optima, UnitedHealthcare), most of your questions about benefits, appointments, or finding a specific provider should go directly to your MCO's member services line.
• Fee-for-Service (FFS) Medicaid: For services covered under FFS (which are becoming less common but still exist for certain populations or specific services), or if you are a provider needing to contact DMAS directly for FFS claims, you'll reach out to DMAS.
• DMAS Main Lines: For general inquiries about Virginia Medicaid policy, provider enrollment (for providers), or issues that cannot be resolved by your MCO, DMAS is the appropriate contact.

Direct Contact for Virginia Medicaid Managed Care Organizations (MCOs)

Most Virginia Medicaid members receive their healthcare services through one of several Managed Care Organizations (MCOs). Each MCO has its own dedicated member services and provider relations phone numbers. It's vital to identify your specific MCO, which is usually listed on your Medicaid ID card, before making a call. Our analysis shows that preparing details beforehand drastically improves call efficiency. — Business Management Degree: Job Opportunities & Career Paths

Here are the primary contact numbers for the major Virginia Medicaid MCOs. Always check your most recent ID card or the MCO's official website for the most up-to-date information. — Tiny Homes For Sale In Tulsa: Find Your Perfect Small Space

• Anthem HealthKeepers Plus:
  • Member Services: 1-800-901-0020 (TTY 711)
  • Provider Services: 1-800-901-0020
  • Website: https://www.anthem.com/virginia-medicaid/
• Molina Healthcare of Virginia:
  • Member Services: 1-800-424-4518 (TTY 711)
  • Provider Services: 1-804-510-1414
  • Website: https://www.molinahealthcare.com/members/va/en-US/Pages/home.aspx
• Optima Health Community Care:
  • Member Services: 1-800-881-2166 (TTY 711)
  • Provider Services: 1-844-310-8200
  • Website: https://www.optimahealth.com/medicaid
• UnitedHealthcare Community Plan:
  • Member Services: 1-800-979-9008 (TTY 711)
  • Provider Services: 1-800-979-9008
  • Website: https://www.uhccommunityplan.com/virginia/medicaid
• Virginia Premier Health Plan:
  • Member Services: 1-800-727-7536 (TTY 711)
  • Provider Services: 1-800-727-7536
  • Website: https://www.virginiapremier.com/

Key Contacts for MCO-Specific Needs

Each MCO offers a range of services via phone, including:

• Finding an in-network Virginia Medicaid Provider Phone Number for a specific specialty.
• Questions about covered benefits, co-pays, or deductibles.
• Help with scheduling appointments or transportation to medical visits.
• Reporting changes to your personal information.
• Assistance with grievance and appeals processes.

Connecting with Virginia's Fee-for-Service (FFS) Medicaid

While most Virginia Medicaid members are in MCOs, some specialized services and populations, particularly those related to long-term care or specific waiver programs, may still be covered under the traditional Fee-for-Service (FFS) model. For providers, understanding FFS contact points is essential for billing and claims for these specific services.

Key Contacts for FFS Providers

For providers who serve FFS members, or for members receiving FFS benefits, the Virginia Department of Medical Assistance Services (DMAS) is the primary point of contact. DMAS oversees the FFS program, including claims processing, provider enrollment, and policy interpretation.

• DMAS Member Helpline (for FFS members or general inquiries):
  • Phone: 1-800-432-5924 (Statewide, Monday-Friday, 8:00 AM - 5:00 PM EST)
  • TTY: 1-800-343-0634
• DMAS Provider Helpline (for FFS claims, billing, and enrollment):
  • Phone: 1-800-552-8627 (Statewide, Monday-Friday, 8:00 AM - 5:00 PM EST)
  • This is the critical Virginia Medicaid Provider Phone Number for FFS administrative support.

Billing and Claims Support for FFS

Providers dealing with FFS claims should utilize the DMAS Provider Helpline for questions regarding:

• Claim submission and processing status.
• Prior authorization requirements for FFS services.
• Explanation of Benefits (EOB) inquiries.
• Provider manuals and billing guidelines.

It is important to note that DMAS provides extensive resources on their official website for FFS providers, including online portals and downloadable forms. (Source: https://www.dmas.virginia.gov/) This aligns with recognized industry standards for transparency and accessibility.

DMAS and Specialized Program Contact Information

Beyond FFS and MCO-specific helplines, the Virginia Department of Medical Assistance Services (DMAS) offers several specialized contact points for unique programs or administrative needs. These lines are crucial for addressing complex issues, seeking specific program information, or navigating provider enrollment processes. — Gamecocks Football: News, Scores, And More

DMAS Member Helpline

This line serves as a central hub for beneficiaries with general questions about Virginia Medicaid, eligibility, or if they are unsure which MCO they belong to. It's also the go-to for FFS members.

• Statewide Member Services: 1-800-432-5924
• TTY: 1-800-343-0634

Provider Enrollment Services

For healthcare professionals and facilities looking to enroll as Virginia Medicaid providers, or existing providers with enrollment-related questions, a dedicated line is available.

• DMAS Provider Enrollment Unit: 1-888-829-5373
  • This is a key Virginia Medicaid Provider Phone Number for administrative and credentialing support.

Behavioral Health Services

Virginia Medicaid covers a broad range of behavioral health services. For specific inquiries regarding mental health or substance use disorder benefits, or to find a behavioral health provider, contacting the appropriate MCO is usually the first step. However, DMAS also provides oversight.

• Virginia Mental Health Access Program (VMAP): (for pediatric primary care providers consulting on mental health care)
  • Phone: 1-888-2VA-MAPS (1-888-282-6277)
• Substance Abuse Treatment Services: For specific treatment locators, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) offers resources, often directing individuals back to their MCO or DMAS for benefit specifics.
  • DBHDS Contact: 804-786-3921 (General Info, not direct treatment line)

Long-Term Services and Supports (LTSS)

Individuals seeking information on home and community-based waiver programs or nursing facility services can also contact DMAS or their MCO. Specific programs have dedicated teams within DMAS.

• DMAS LTSS Division: Inquiries often routed through the main DMAS Provider or Member Helpline initially, then directed to specialists.

For more detailed information, the official Virginia DMAS website (https://www.dmas.virginia.gov/) is an invaluable resource, offering manuals, forms, and updates that uphold the authority of the state's Medicaid program. They actively publish data on program changes and initiatives, ensuring up-to-date guidance for beneficiaries and providers alike. (Source: https://www.dmas.virginia.gov/for-providers/)

Tips for Effective Communication with Virginia Medicaid Providers and Support

Successfully navigating conversations with Virginia Medicaid—whether it's an MCO, FFS provider, or DMAS—requires preparation and clarity. We've found that understanding your MCO is key, and adopting a proactive approach can significantly improve outcomes. These tips, derived from practical scenarios, are designed to make your calls more productive.

Before You Call

1. Gather Your Information: Have your Medicaid ID number, MCO name, date of birth, and any relevant dates of service or claim numbers ready. For providers, this includes NPI, Tax ID, and patient-specific details.
2. Clearly Define Your Question/Issue: Write down exactly what you need to ask or explain. Be specific. For example, instead of