Important Information from DMAS
February 21, 2023
We have been asked to share this important message with our Medicaid managed care provider community, including billing and non-billing, servicing, ordering, referring, or prescribing providers who serve members through managed care organizations (MCOs) or Fee-For-Service (FFS), or both.
In accordance with the federal 21st Century Cures Act, over the last several months, the Department of Medical Assistance Services (DMAS) and its managed care plans have been notifying providers to enroll as a provider directly with DMAS through the Department’s Medicaid Provider Services Solution (PRSS) enrollment portal.
Important Deadline for Managed Care Network Providers
Effective April 1, 2023, Virginia Medicaid MCOs will be prohibited from paying network providers until the provider is enrolled with the DMAS through the PRSS portal.
Two Action Items for Providers:
- Enroll all National Provider Identifier (NPI) numbers in PRSS for all of the provider’s servicing, billing, ordering, referring, or prescribing providers.
- Providers should initiate their enrollment application in PRSS, via virginia.hppcloud.com now to avoid disruption to claims payments.
- Only one enrollment application per NPI/service location is necessary in PRSS, even if a provider participates with more than one MCO.
- Providers with multiple National Provider Identifier (NPI) numbers must enroll all of their NPIs in PRSS.
- Providers with multiple service locations must enroll all service locations.
- MCO network providers who have already enrolled all of their NPIs and all of their service locations with Medicaid fee-for-service do not need to re-enroll in PRSS. Providers who are not certain if all NPIs and service locations are enrolled should verify their enrollment status in PRSS (see #2 below).
- Check your PRSS enrollment status
- DMAS has posted a spreadsheet that lists all active, PRSS enrolled Virginia Medicaid providers.
- Providers should check their enrollment status for all NPIs and service locations before enrolling in PRSS, including for servicing and billing providers and also for non-billing NPIs, including ordering, referring, and prescribing providers.
- The Virginia Medicaid provider spreadsheet is located at: MCO Provider Network Resources | MES (virginia.gov)
- Providers can download the spreadsheet to verify that all of their NPIs and service locations are enrolled.
- If any of the provider’s NPIs or service locations are missing from the spreadsheet, the provider must enroll the missing NPIs or service locations using the PRSS portal (see #1 above to enroll).
Providers can contact the Gainwell helpdesk with any questions they have about the content for their NPIs in the spreadsheet, or about the Virginia Medicaid provider enrollment process, at 1-888-829-5373, or by email: email@example.com