Virginia Medicaid — Virginia Medicaid (Cardinal Care)
| Program name | Virginia Medicaid (Cardinal Care) |
|---|---|
| Provider portal | https://www.dmas.virginia.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 Virginia Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Virginia
The Blue Cross Blue Shield Association licensee in Virginia is Anthem Blue Cross and Blue Shield of Virginia (Elevance Health). See the Anthem (Elevance Health) payer guide for payer ID, timely filing, prior auth, and appeal procedures.
Top commercial payers in Virginia
The dominant commercial insurers operating in Virginia, 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 Virginia
Virginia Medicaid (Cardinal Care) contracts with the following managed-care organizations to administer Medicaid benefits in Virginia. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
State-specific regulations affecting Virginia billing
- Va. Code §38.2-3445.01+ (Balance Billing Law — OON billing at in-network facilities, effective 2021)
- Va. Code §38.2-3407.15 (Ethics and Fairness in Carrier Business Practices — prompt pay 40 days electronic clean claim)
- Va. Code §32.1-137.010 (hospital financial assistance policies)
Provider licensing & enrollment in Virginia
Providers enroll via Virginia Medicaid Web Portal (PRSS — Provider Services Solution). Cardinal Care MCOs use centralized credentialing vendor plus CAQH.
Major health systems headquartered in Virginia
| Health system | Headquarters |
|---|---|
| Sentara Health | Norfolk, VA |
| HCA Virginia Health System | Richmond, VA |
| Inova Health System | Falls Church, VA |
| VCU Health | Richmond, VA |
| Carilion Clinic | Roanoke, VA |
Frequently asked questions — Virginia billing
What is the Virginia Medicaid program called?
Virginia's Medicaid program is known as Virginia Medicaid (Cardinal Care). Providers enroll and manage claims through the provider portal at https://www.dmas.virginia.gov.
What is the Virginia Medicaid timely filing limit?
Virginia Medicaid (Cardinal 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; Virginia'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 Virginia Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for Virginia Medicaid (Cardinal 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 Virginia?
The dominant commercial payers in Virginia include Anthem (Elevance Health), UnitedHealthcare, Aetna, Cigna, CareFirst BCBS, along with the BCBS licensee Anthem Blue Cross and Blue Shield of Virginia (Elevance Health). 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 Virginia?
Virginia Medicaid (Cardinal Care) contracts with 6 Medicaid MCOs tracked in the QuickIntell registry, including Anthem (Elevance Health), Aetna, Molina Healthcare, UnitedHealthcare, Humana. MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in Virginia?
Virginia has 3 tracked state-level statutes that affect medical billing and RCM: Va. Code §38.2-3445.01+ (Balance Billing Law — OON billing at in-network facilities, effective 2021); Va. Code §38.2-3407.15 (Ethics and Fairness in Carrier Business Practices — prompt pay 40 days electronic clean claim); Va. Code §32.1-137.010 (hospital financial assistance policies). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Virginia with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to Virginia Medicaid (Cardinal 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 Virginia Medicaid and the member ID card before submission.