Vermont Medicaid — Vermont Medicaid (Green Mountain Care)
| Program name | Vermont Medicaid (Green Mountain Care) |
|---|---|
| Provider portal | https://dvha.vermont.gov |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Vermont Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Vermont
The Blue Cross Blue Shield Association licensee in Vermont is Blue Cross and Blue Shield of Vermont. This licensee is not yet in the QuickIntell payer registry. See the full payer directory or the BCBSA national site for a provider-portal link.
Top commercial payers in Vermont
The dominant commercial insurers operating in Vermont, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Vermont
Vermont Medicaid MCO data has not yet been populated in the registry.
Medicare contractor and active LCDs in Vermont
Wellpoint Federal is the Medicare A/B MAC for Vermont: Part A and Part B fee-for-service claims from Vermont go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to Noridian Healthcare Solutions, LLC as the DME MAC. Home health and hospice claims are processed by Wellpoint Federal. In the current Medicare Coverage Database export, 147 active LCDs from these contractors apply to Vermont claims.
- Wellpoint Federal
A/B MAC (Part A and Part B claims); Home health and hospice MAC
- Noridian Healthcare Solutions, LLC
DME MAC (durable medical equipment and supplies)
Selected active Wellpoint Federal policies for Vermont
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L33627 Non-Invasive Vascular Studies
- L33394 Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
- L35936 Facet Joint Interventions for Pain Management
- L39036 Epidural Steroid Injections for Pain Management
- L35000 Molecular Pathology Procedures
- L33577 Transthoracic Echocardiography (TTE)
- L33631 Outpatient Physical and Occupational Therapy Services
- L33632 Psychiatry and Psychology Services
- L33557 Cardiac Catheterization and Coronary Angiography
- L33569 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
- L33636 Routine Foot Care and Debridement of Nails
- L33622 Pain Management - Injection of tendon sheaths, ligaments, bursa, and ganglion cysts
Equipment, home health and hospice policies that apply in Vermont
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L33792 Wheelchair Options/Accessories
- L33797 Oxygen and Oxygen Equipment
- L33393 Hospice - Determining Terminal Status
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting Vermont billing
- 8 V.S.A. §4089b (Vermont prompt pay — 30 days electronic clean claim)
- 18 V.S.A. §9418 (Vermont Health Care Administrative Simplification — claim standards)
- Act 72 of 2019 (Vermont balance billing / OON protections)
Provider licensing & enrollment in Vermont
Providers enroll via Vermont Medicaid Provider Enrollment (vtmedicaid.com, DXC). OneCare Vermont has separate ACO participation agreement.
Major health systems headquartered in Vermont
| Health system | Headquarters |
|---|---|
| University of Vermont Health Network (UVMHN) | Burlington, VT |
| Dartmouth Health (border facilities) | Lebanon NH, VT |
| Rutland Regional Medical Center | Rutland, VT |
| Northwestern Medical Center | St. Albans, VT |
| Central Vermont Medical Center (UVMHN) | Berlin, VT |
Frequently asked questions — Vermont billing
What is the Vermont Medicaid program called?
Vermont's Medicaid program is known as Vermont Medicaid (Green Mountain Care). Providers enroll and manage claims through the provider portal at https://dvha.vermont.gov.
What is the Vermont Medicaid timely filing limit?
Vermont Medicaid (Green Mountain Care) requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Vermont's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Vermont Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for Vermont Medicaid (Green Mountain Care). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Vermont?
The dominant commercial payers in Vermont include MVP Health Care, Cigna, Aetna, UnitedHealthcare, Humana, along with the BCBS licensee Blue Cross and Blue Shield of Vermont. Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Vermont?
Vermont Medicaid MCO data has not yet been populated in the registry. Consult the state Medicaid portal for the current MCO roster.
What state-specific billing regulations apply in Vermont?
Vermont has 3 tracked state-level statutes that affect medical billing and RCM: 8 V.S.A. §4089b (Vermont prompt pay — 30 days electronic clean claim); 18 V.S.A. §9418 (Vermont Health Care Administrative Simplification — claim standards); Act 72 of 2019 (Vermont balance billing / OON protections). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Vermont with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to Vermont Medicaid (Green Mountain Care) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Vermont Medicaid and the member ID card before submission.