VA Medicaid Provider Enrollment in 2026: The Complete Step-by-Step Guide via DMAS PRSS

va medicaid provider enrollment is the federally mandated state-administered process governed by 21st Century Cures Act Section 5005 and 42 CFR Part 455. Providers register with DMAS via the PRSS Portal.

Critical disambiguation: VA here means Virginia (the state), not Veterans Affairs (federal). The va medicaid provider enrollment hotline is 1-888-829-5373 toll-free or 804-270-5105 local, Monday through Friday 8 AM to 5 PM Eastern.

Virginia Medicaid faces a critical operational inflection point in 2026. Per the DMAS Bulletin dated June 23, 2025, effective July 1, 2025, DMAS eliminated the historic 90-day grace period following license expiration before terminating provider enrollment agreements. License lapse equals immediate PRSS termination equals no Medicaid revenue.

This guide covers provider enrollment, not member enrollment. Members apply through Cover Virginia at 1-855-242-8282. Virginia Medicaid serves more than 2 million Virginians through Cardinal Care managed care, fee-for-service, and waiver programs.

Per the CMS Federal Register Notice of December 3, 2025, the CY 2026 federal provider enrollment application fee is $750 for institutional providers (effective January 1 through December 31, 2026).

Federal law under the 21st Century Cures Act requires ALL providers (billing, servicing, ordering, referring, or prescribing) who serve Medicaid members through managed care organizations or fee-for-service to enroll directly with DMAS through PRSS. Cardinal Care MCOs are PROHIBITED from contracting with providers who are not enrolled in PRSS.

Starting June 1, 2026, all providers must log in to FFS Service Authorization through MES single sign-on.

This guide covers the Virginia Medicaid Enterprise system via DMAS, MES, PRSS, and Gainwell Technologies. It covers the federal framework under the 21st Century Cures Act and 42 CFR Part 455. It walks through the seven critical 2026 regulatory updates: license grace period elimination effective July 1, 2025; H.R.

1 federal Medicaid restructuring with cascading 2026-2027 implementation; $750 CY 2026 application fee; MES single sign-on transition June 1, 2026; SNF and Hospice risk screening update December 1, 2025; PA turnaround shortened to 7 calendar days; and pharmacy institutional fee treatment August 1, 2025.

It also covers the standard PRSS enrollment pathway, the Cardinal Care MCO contracting layer with all 5 MCOs, the DentaQuest separate dental pathway, the DBHDS behavioral health coordination, the DD Waivers carved-out from MCOs, and the Foster Care Specialty Plan.

We're MedSole RCM. We've credentialed more than 4,000 providers across all 50 states at $99 per insurance with a 99 percent first-time approval rate and the fastest Virginia Medicaid enrollment approval timeline in the United States through continuous DMAS PRSS follow-up.

Industry credentialing companies charge $150 to $300 per payer with 60 to 120 day passive timelines that leave Virginia providers waiting. MedSole RCM is the most affordable va medicaid provider enrollment partner in the United States with the fastest path to PRSS approval. No setup fees. No hidden charges. No annual contracts.

The lowest structured pricing in the US RCM market.

If you're a Virginia group practice, a DME supplier, a SNF or Hospice provider, a behavioral health agency coordinating DBHDS licensing, an out-of-state telehealth practice, or an institutional provider managing the $750 CY 2026 application fee, this guide answers the operational questions DMAS documentation skips.

Virginia Medicaid enrollment specialists handle PRSS portal navigation, Pre-Checklist generation, ATN tracking, $750 fee processing, and multi-payer credentialing across all 5 Cardinal Care MCOs simultaneously.

Virginia Medicaid operates with operational specificity that changed materially in 2025-2026. Knowing the DMAS-PRSS distinction, the Cardinal Care 5-MCO unified brand structure, the DD Waiver carve-out, the DentaQuest separate enrollment pathway, and the three-layer governance framework (federal floor, DMAS state implementation, Cardinal Care multi-payer network) prepares you for the operational depth ahead.

Section 2 covers the big picture every Virginia provider needs.

Virginia Medicaid in 2026: The Big Picture Providers Must Understand

Virginia Medicaid covers more than 2 million Virginians as of 2026. The Virginia Department of Medical Assistance Services (DMAS) administers Virginia Medicaid through the Medicaid Enterprise System (MES), with Gainwell Technologies serving as the PRSS vendor operating the Provider Services Solution Portal at virginia.hppcloud.com.

Virginia's unified Medicaid brand is Cardinal Care, launched October 2023. Approximately 95 percent of Virginia Medicaid members receive services through Cardinal Care.

Who Virginia Medicaid Covers (More Than 2 Million Virginians)

Virginia Medicaid serves more than 2 million Virginians including low-income children, pregnant women, parents and caretakers, working-age adults under the ACA expansion population (added January 2019), seniors, people with disabilities, and children with disabilities through DD Waivers. Total enrollment exceeds 2 million as of 2026.

Virginia Medicaid covers comprehensive medical services through Cardinal Care managed care for most members and through fee-for-service for DD Waiver members and specific specialty pathways. FAMIS (Family Access to Medical Insurance Security) is Virginia's Children's Health Insurance Program (CHIP), now branded under Cardinal Care.

How DMAS Administers Medicaid Through MES, PRSS, and Gainwell Technologies

DMAS is the single State Medicaid agency in Virginia.

DMAS administers Medicaid through three operational components. First, the Medicaid Enterprise System (MES), the modular system replacing the legacy VAMMIS. Second, the Provider Services Solution (PRSS) Portal, the module within MES handling provider enrollment, revalidation, maintenance, and member eligibility verification. Third, Gainwell Technologies, the PRSS vendor and fiscal agent operating PRSS on behalf of DMAS at 1-888-829-5373 toll-free.

MES enables DMAS to meet federal requirements for flexible, upgradable, secure information systems. PRSS minimizes paper transactions and improves accuracy and efficiency between providers and DMAS. Gainwell handles provider enrollment inquiries at vamedicaidproviderenrollment@gainwelltechnologies.com.

Virginia Medicaid's Six Program Layers Providers Encounter

Virginia Medicaid providers encounter six distinct program layers. First, Medicaid Fee-for-Service (FFS), administered directly by DMAS through MES, where providers bill DMAS directly. Second, Cardinal Care Managed Care, Virginia's unified managed care program serving most Medicaid and FAMIS members through 5 contracted MCOs.

Third, DD Waivers (Building Independence, Family and Individual Support, Community Living), carved-out from MCOs and delivered exclusively through FFS Medicaid.

Fourth, Foster Care Specialty Plan, administered statewide by Anthem HealthKeepers Plus for foster care, adoption assistance, and youth aged out of foster care under 26. Fifth, FAMIS (Virginia's CHIP for children whose families earn slightly above traditional Medicaid eligibility). Sixth, dental coverage administered through DentaQuest under Cardinal Care Smiles statewide program.

Important: dental providers do NOT enroll through PRSS; they use a separate DentaQuest pathway.

Cardinal Care , Virginia's Unified Medicaid Managed Care Brand (October 2023)

Cardinal Care is the unified Medicaid managed care brand DMAS launched in October 2023, merging the legacy Medallion 4.0 (families, children, expansion adults) and Commonwealth Coordinated Care Plus (CCC Plus, long-term care enrollees) programs into one program. All managed care and fee-for-service Medicaid members are part of Cardinal Care.

Effective July 1, 2025, Cardinal Care operates with 5 MCOs: Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons in Virginia (NEW July 2025, replacing Molina Healthcare which exited), Sentara Community Plan, and UnitedHealthcare Community Plan. H.R. 1 federal legislation enacted July 4, 2025 brings additional structural changes through 2026-2027. Section 3 covers all seven critical 2026 updates.

Virginia Medicaid Member Enrollment vs Provider Enrollment: Critical Disambiguation

Provider enrollment and member enrollment are operationally distinct in Virginia Medicaid. Healthcare providers enroll through DMAS via the PRSS Portal at virginia.hppcloud.com to receive Medicaid reimbursement. Individuals seeking Medicaid coverage as patients apply through Cover Virginia at 1-855-242-8282 or through CommonHelp at commonhelp.virginia.gov.

Member application uses different forms, a separate eligibility determination process at the local Department of Social Services (DSS) level (unique Virginia structural distinction: DSS determines member eligibility, not DMAS directly), and entirely different timelines. This guide covers provider enrollment exclusively. Members are directed to Cover Virginia for coverage applications.

Virginia Medicaid is at a critical inflection point in 2026 with structural changes affecting every enrolled provider. MedSole's Medicaid credentialing experts framework walks through the multi-state Medicaid credentialing complexity that Virginia providers face given the upcoming H.R. 1 implementation and license grace period elimination. Section 3 covers the seven critical 2026 updates.

What's New in 2026: 7 Critical Updates Every Virginia Medicaid Provider Must Know

Seven material 2026 updates affect va medicaid provider enrollment right now. DMAS eliminated the 90-day license grace period effective July 1, 2025. H.R. 1 federal Medicaid law was enacted July 4, 2025 with cascading implementation through 2027. The CY 2026 federal application fee is $750.

MES single sign-on becomes mandatory June 1, 2026. SNF and Hospice risk screening updated December 1, 2025. Prior authorization shortened to 7 calendar days. Five-year revalidation cycle enforcement continues.

Update 1: License Expiration 90-Day Grace Period ELIMINATED (Effective July 1, 2025) , Highest Urgency

The single most urgent 2025-2026 operational change: Per the DMAS Bulletin "Updated Provider Enrollment Requirements - Effective July 1, 2025", DMAS eliminated the historic 90-day grace period following license expiration.

Historical context: DMAS previously allowed a 90-day grace period for providers to renew expired licenses before enrollment termination. Beginning July 1, 2025, this grace period no longer applies, as it caused delays in providers having appropriate enrollment and consequently affected claims.

New rule operational reality: All new or returning providers are enrolled in PRSS based on the month they apply or request reinstatement after any lapse in PRSS enrollment participation. License lapse equals immediate enrollment termination equals no FFS payments AND no Cardinal Care MCO payments.

Provider impact severity: EXTREME. Every provider must ensure license and certification is active in PRSS for the provider's type and specialty. Multiple NPIs and multiple service locations each require independent license tracking. Implement license renewal tracking 90 or more days in advance for every provider, every NPI, every service location.

Update 2: H.R. 1 Federal Medicaid Restructuring (Enacted July 4, 2025) , Cascading 2026-2027 Implementation

A new federal law enacted on July 4, 2025 made major changes to Medicaid affecting Virginia providers through 2026-2027 with four cascading implementation deadlines.

Work/Community Engagement Requirements: For the expansion population, H.R. 1 requires enrollees to engage in qualifying activity at least 80 hours per month. DMAS verifies this upon application and every six months. Implementation deadline: no later than December 31, 2026.

Semi-Annual Eligibility Re-Determinations: Eligibility re-determinations for the expansion population now occur every six months versus annually. Major increase in patient eligibility verification workflow burden for providers.

Noncitizen Eligibility Changes (Effective October 1, 2026): Non-pregnant adults with certain immigration statuses no longer covered under full-service Medicaid. Process begins summer 2026. Member coverage changes begin fall 2026.

Retroactive Coverage Reduction (Effective January 1, 2027): Retroactive payments limited to 1 month for expansion population, 2 months for all other Medicaid populations and CHIP/FAMIS (currently 3 months for all). Provider revenue cycle impact: EXTREME. Eligibility verification at every visit becomes business-critical.

Anticipate substantial patient disenrollment events in late 2026. Virginia has proposed budget amendments increasing CHIP eligibility to 305 percent of federal poverty level and establishing a workgroup focused on mitigating coverage losses for children.

Update 3: $750 CY 2026 Federal Application Fee + Pharmacy Institutional Treatment

Per the CMS Federal Register Notice published December 3, 2025, the CY 2026 federal provider enrollment application fee is $750 for institutional providers (effective January 1 through December 31, 2026). Federal authority: 42 CFR §455.460.

When the fee applies: Institutional providers pay at first-time enrollment, when adding a new practice location, or at revalidation. Individual physicians and non-physician practitioners are exempt. Physician groups, dental groups, and therapy groups are exempt. Providers already enrolled in Medicare or another state Medicaid/CHIP can claim a "paid to another state" exemption with PECOS validation through the PRSS workflow.

Virginia-specific pharmacy update: Per the DMAS Pharmacy Bulletin effective August 1, 2025, pharmacies enrolled under specific provider class types are treated as institutional provider types subject to the application fee. Notable exemption: Provider Class Type 268-Pharmacist.

Critical disambiguation: Virginia's MES portal hosts an OLDER "Application Fee Submission Form" showing a $631 fee with "REV 4/15" form revision. Providers should NOT treat that legacy PDF as authoritative. The CY 2026 amount is $750.

Update 4: MES Single Sign-On Mandatory for FFS Service Authorization (Effective June 1, 2026)

Per the DMAS Bulletin "New Single Sign-On Requirement for FFS Service Authorization Requests with Acentra ANG Platform Through DMAS MES Effective April 27, 2026", DMAS implemented a major workflow change for FFS service authorization.

Starting April 27, 2026: A new tile is available in DMAS MES allowing submission of FFS service authorization requests via Acentra Health's Atrezzo Next Generation (ANG) platform. Existing DMAS-MES users with access to PRSS, AIMS, etc. can log into MES with existing credentials and find the new tile named "FFS Service Authorization."

Starting June 1, 2026: ALL providers MUST log in to the FFS Service Authorization tile through MES single sign-on. Non-compliance after June 1, 2026 disrupts authorization workflow and delays claims payment. DMAS contracts with Acentra Health (formerly Kepro) for service authorization management.

Update 5: SNF and Hospice Risk Screening Update (Effective December 1, 2025)

Per the DMAS Bulletin "Updated Risk Screening Requirements for Skilled Nursing Facility and Hospice Providers", DMAS implemented escalated risk screening for SNF and Hospice providers effective December 1, 2025.

New screening requirements: HIGH-risk screening for initial enrollment, re-enrollment, and changes of ownership. MODERATE-risk screening for revalidations. HIGH-risk screening triggers fingerprint-based criminal background checks under 42 CFR §455.434 for the provider AND any person with 5 percent or greater direct or indirect ownership interest.

MODERATE-risk screening adds pre-enrollment or post-enrollment unannounced site visits under 42 CFR §455.432. HIGH-risk screening typically extends Virginia Medicaid enrollment timelines by 30 to 60 days beyond standard processing.

Update 6: Prior Authorization Turnaround Times Shortened to 7 Calendar Days

A federal CMS Interoperability and Prior Authorization Final Rule shortens standard service authorization decision timeframes from 14 days down to 7 calendar days. Rules apply to both Managed Care AND Medicaid/CHIP Fee-for-Service.

Specific requirements: Standard (non-urgent) requests require response within 7 calendar days (down from 14). Expedited (urgent) requests require response within 72 hours. Decision details must include a specific reason for any denial. DMAS and MCOs must publicly report annual service authorization metrics. First report due March 31, 2026.

Provider revenue cycle impact: Faster PA decisions mean improved cash flow. But submissions must be clean and complete on first pass. Incomplete submissions are still returned, eating into the shortened response window.

Update 7: Five-Year Revalidation Cycle + Manage Revalidation Panel (NEW PRSS Feature)

Five-year revalidation cycle continues under 42 CFR §455.414. DMAS notification cadence: 90 days prior to revalidation deadline via email or U.S. Mail per PRSS communications preferences; 60 days prior, first reminder; 30 days prior, final reminder. Reminders come from a Gainwell "no-reply" email that must be safelisted to prevent missed reminders.

NEW Manage Revalidation Panel: DMAS launched a new "Manage Revalidation" panel in the PRSS Provider Portal that shows in-process revalidation tracking numbers (ATNs) for the base ID and locations where the user is an Authorized Administrator. This significantly reduces dependence on matching multiple email reminders and is a major operational improvement for multi-location providers.

DMAS explicitly warns providers who don't revalidate by due date can have Virginia Medicaid participation TERMINATED from FFS AND ALL Cardinal Care MCO networks until successful PRSS revalidation.

Seven 2026 updates means va medicaid provider enrollment is at a critical inflection point. MedSole's Virginia Medicaid enrollment service handles the entire 2026 compliance burden at $99 per insurance with the fastest Virginia Medicaid enrollment approval timeline through continuous DMAS PRSS follow-up. Industry credentialing companies charge $150 to $300 per payer.

Next: the foundational distinction every Virginia provider needs. DMAS PRSS enrollment first. Then Cardinal Care MCO contracting. These aren't synonyms. They're sequential operational steps with the federal 21st Century Cures Act enforcing PRSS as the mandatory foundation.

The Two-Part Virginia Medicaid Enrollment Model: PRSS First, Then Cardinal Care MCO Contracting

Virginia Medicaid enrollment is a two-part process per DMAS guidance. Part 1: enroll and maintain your DMAS Virginia Medicaid enrollment through the PRSS Provider Portal at virginia.hppcloud.com.

Part 2: contract and credential separately with each Cardinal Care MCO (Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons in Virginia, Sentara Community Plan, UnitedHealthcare Community Plan). Contracting with a Cardinal Care MCO does NOT automatically guarantee DMAS PRSS enrollment.

Part 1: DMAS PRSS Enrollment Through the Provider Services Solution Portal (The State Foundation)

Part 1 is the foundational state-level enrollment. Providers enroll through DMAS using the PRSS Provider Portal at virginia.hppcloud.com.

The DMAS PRSS process involves generating the Enrollment Pre-Checklist (based on Enrollment Type, Provider Type, Specialty, Tax ID Type, Medicare-enrolled status, and programs accepted), submitting supporting documentation, entering 10-digit NPI and 9-digit Tax ID, application screening based on risk classification, Application Tracking Number (ATN) assignment, and approval notification upon successful screening.

Per the DMAS Bulletin July 1, 2025, providers must ensure enrollment is current and active for all service locations and provider types. Per the DMAS Fee-for-Service Providers page, all Virginia Medicaid providers must submit claims electronically via EDI through a clearinghouse or Direct Data Entry (DDE) through the Virginia Medicaid web portal, and receive payments via Electronic Funds Transfer (EFT).

Part 2: Cardinal Care MCO Contracting (The Multi-Payer Layer)

Part 2 is the multi-payer credentialing layer.

After DMAS PRSS approval, providers must contract separately with each Cardinal Care MCO they want to participate with: Aetna Better Health of Virginia, Anthem HealthKeepers Plus (including the Foster Care Specialty Plan), Humana Healthy Horizons in Virginia (NEW July 2025, replaced Molina Healthcare), Sentara Community Plan, and UnitedHealthcare Community Plan.

Each operates a distinct Provider Agreement workflow with reimbursement rates, fee schedules, prior authorization rules, dispute procedures, and timely filing windows. All 5 Cardinal Care MCOs use CAQH ProView as primary credentialing data infrastructure. Submit roster updates simultaneously where applicable.

Critical operational rule: in order for Cardinal Care MCOs to complete credentialing, you must first be fully approved as an enrolled provider with DMAS through PRSS.

Why Cardinal Care MCO Credentialing Requires DMAS PRSS Approval First (21st Century Cures Act Federal Mandate)

Critical operational sequencing rule rooted in federal law: Per the federal 21st Century Cures Act Section 5005, ALL providers (billing, servicing, ordering, referring, or prescribing) who serve Medicaid members through MCO networks or fee-for-service must enroll directly with DMAS through PRSS. CMS is monitoring compliance closely.

Per the DMAS Managed Care Network Providers page, Cardinal Care MCOs are PROHIBITED from contracting with providers who don't enroll and revalidate as required in PRSS. Providers who received termination letters cannot have network participation reinstated until PRSS enrollment is completed.

Attempting to credential with a Cardinal Care MCO before receiving DMAS PRSS approval is the most common avoidable cause of enrollment delays. Our complete CAQH ProView management guide walks through the CAQH layer in operational depth.

Dental Providers Critical Exception: Enroll Through DentaQuest, NOT PRSS

Critical disambiguation surfaced early to prevent dental provider confusion: Dental providers should NOT enroll through PRSS at this time.

Per DMAS guidance, dental providers who are currently participating and need to recredential, or those who wish to enroll for the first time, should enroll directly through DentaQuest at CredEnrollment@DentaQuest.com or by calling 800-233-1468. DentaQuest administers Cardinal Care Smiles, Virginia's statewide dental program under Cardinal Care.

Knowing the two-part model plus the DMAS-before-MCO sequencing rule plus the DentaQuest dental exception prevents the most common Virginia Medicaid enrollment mistakes. Section 5 covers Virginia's provider type pathways and the federal risk-based screening that determines application scrutiny.

Virginia Provider Type Pathways and Risk-Based Screening Under DMAS

Virginia Medicaid operates enrollment type selection plus federal categorical risk-level assignment under 42 CFR §455.450: Limited, Moderate, or High. SNF and Hospice providers face escalated screening per the December 1, 2025 DMAS update.

DBHDS licensing coordination affects behavioral health providers separately. Pharmacies receive institutional treatment for the $750 CY 2026 application fee per the August 1, 2025 DMAS bulletin.

Virginia Medicaid Enrollment Types and Provider Type Selection

On the PRSS Provider Portal, providers select enrollment type during the Pre-Checklist generation step. Common Virginia enrollment types include four categories.

Individual: Solo practitioners enrolling independently. Requires NPI Type 1 (individual). Most common pathway for solo physicians, nurse practitioners, dentists (note: dental via DentaQuest), and behavioral health providers.

Group: Organizational entities , physician groups, dental groups, therapy groups, hospitals, nursing facilities, FQHCs. Group enrollment requires NPI Type 2 (organizational).

Individual Within Group (IG): Solo practitioners affiliating with an existing enrolled group practice. Requires NPI Type 1 (individual) AND verification of the group's existing enrollment.

Ordering/Prescribing/Referring (OPR): Providers who don't bill directly but order, prescribe, or refer services for Virginia Medicaid members.

Critical PRSS warning: For IG or OPR enrollment, check the latest active provider extract first and use the Service Location ID to associate to a new group/facility location rather than submitting a duplicate enrollment.

Virginia Medicaid Provider Type and Specialty Selection via PRSS

After enrollment type, PRSS requires selection of Provider Type and Specialty. The Pre-Checklist matches Provider Type plus Specialty plus Tax ID Type plus Medicare-enrolled status plus programs accepted to identify required credentials and documentation.

Common Virginia provider types: Physician (MD/DO), Advanced Practice Registered Nurse (APRN), Physician Assistant, Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Nursing Facility, Home Health Agency, DMEPOS supplier, Hospital, Behavioral Health Agency, FQHC, RHC (Rural Health Clinic), AHEC, NEMT, Pharmacy, ASC, Hospice, SNF, Podiatrist, Optometrist, and Audiologist.

Provider Type and Specialty combination determines the application processing path and screening requirements. Our physician credentialing services pathway walks through specialty-specific operational depth across multiple state Medicaid programs.

Limited Categorical Risk Screening

Limited risk screening covers most Virginia physicians and mid-level practitioners. DMAS verifies provider licenses through Virginia licensing boards (Virginia Board of Medicine for physicians, Virginia Board of Nursing for RNs/APRNs, Virginia Board of Counseling for LPCs, etc.), runs OIG LEIE exclusion checks, runs SAM.gov sanctions checks, and queries federal databases including NPDB.

Limited risk screening typically completes within standard application processing windows. Per the MES Provider FAQ, standard enrollment processing typically takes up to 10 business days, with additional screening requirements (fee, site visit, background check) extending handling time. Limited risk screening follows the federal framework under 42 CFR Part 455 with Virginia DMAS state-specific implementation.

Moderate Categorical Risk Screening (Including Site Visits)

Moderate risk screening adds pre-enrollment or post-enrollment unannounced site visits to Limited screening. Under 42 CFR §455.432, DMAS or its agents conduct site visits to verify information submitted is accurate and to determine compliance with federal and state enrollment requirements.

The visit verifies the practice operates at the listed address as a working clinic. Home health agencies, outpatient therapy clinics, behavioral health agencies, ambulatory surgical centers, FQHCs, and certain HCBS waiver providers typically face Moderate risk screening.

Per the December 1, 2025 DMAS bulletin, SNF and Hospice REVALIDATIONS are now subject to Moderate risk screening (initial enrollments are High risk). Unannounced site visits add 14 to 45 days to standard enrollment timeline.

High Categorical Risk Screening (Including Fingerprint Background Checks)

High risk screening adds fingerprint-based criminal background checks under 42 CFR §455.434 for the provider AND any person with 5 percent or greater direct or indirect ownership interest, including FBI coordination through Virginia state agencies.

High risk providers in Virginia typically include new DME suppliers (subject to the February 27, 2026 CMS Moratorium for new Medicare enrollment), home infusion providers, personal care services, certain home health agencies, and per the December 1, 2025 DMAS bulletin, new SNF and Hospice initial enrollments, re-enrollments, and changes of ownership.

High risk screening typically extends Virginia Medicaid enrollment timelines by 30 to 60 days. The CY 2026 $750 application fee applies to High-risk institutional providers.

SNF and Hospice Risk Screening Escalation (Effective December 1, 2025)

Dedicated coverage of the December 1, 2025 DMAS update affecting SNF and Hospice providers specifically. Per the DMAS Bulletin "Updated Risk Screening Requirements for Skilled Nursing Facility and Hospice Providers":

Initial enrollment, re-enrollment, and changes of ownership: HIGH-risk screening (fingerprint background checks for 5 percent or more owners plus site visits plus all Limited screening), effective December 1, 2025.

Revalidations: MODERATE-risk screening (site visits plus all Limited screening).

Operational impact: Existing SNF and Hospice providers should plan revalidations with the Moderate-risk site visit timing expectation. New SNF and Hospice operators should plan initial enrollment with High-risk fingerprint screening timing expectation.

When DMAS Applies Mandatory High-Risk Screening

DMAS can elevate a provider to High risk screening regardless of provider type in four scenarios: a payment suspension based on credible fraud allegations, an existing Virginia Medicaid overpayment, OIG or state Medicaid exclusion within the previous 10 years, or enrollment within 6 months of a lifted temporary moratorium.

Virginia may impose additional screening methods more stringent than federal regulations.

Virginia may impose additional screening methods more stringent than federal regulations.

DBHDS Behavioral Health Licensing Coordination

Virginia uniquely coordinates behavioral health provider enrollment with the Department of Behavioral Health and Developmental Services (DBHDS). DBHDS licenses behavioral health agencies, certain residential providers, and developmental disability service providers.

Per the DMAS Bulletin on DBHDS licensing of Multisystemic Therapy (MST) providers, DBHDS licensure must be current and aligned with PRSS enrollment for behavioral health providers. Misalignment between DBHDS licensure and PRSS enrollment creates immediate claim denials for behavioral health services.

Knowing your enrollment type, provider type, risk level, SNF/Hospice escalation status, and DBHDS coordination requirement prepares you for the operational depth ahead. Section 6 walks through the complete DMAS PRSS enrollment process in sequential 12-step format with the Pre-Checklist, ATN tracking, and Manage Revalidation Panel.

The DMAS PRSS Enrollment Process: Complete Step-by-Step Walkthrough

How to become a Virginia Medicaid provider follows 12 sequential steps via DMAS through the PRSS Provider Portal: verify eligibility and documentation, generate Enrollment Pre-Checklist, update CAQH ProView, confirm license status (critical post-July 2025), submit W-9 and EFT authorization, complete electronic application, and verify PECOS status.

Next: pay $750 CY 2026 fee if institutional, capture the Application Tracking Number (ATN), complete federal database screening, site visit or fingerprint screening if Moderate/High risk, and receive approval to initiate Cardinal Care MCO credentialing.

Step 1: Verify Eligibility and Gather Required Documentation

Step 1 starts before any PRSS Portal interaction. Confirm you have an active NPI Type 1 (individual provider) registered in NPPES. Group practices need NPI Type 2 (organizational). Solo providers serving group practices need both. Verify your taxonomy code matches your specialty designation.

Active Virginia professional license verified with the Virginia Board of Medicine (physicians), Virginia Board of Nursing (RNs/LPNs/APRNs), Virginia Board of Counseling (LPCs/LCSWs), Virginia Board of Pharmacy (pharmacists), or the relevant Virginia specialty licensing board. Per the DMAS Bulletin July 1, 2025, license must be active during enrollment. The 90-day grace period no longer applies.

Step 2: Access the PRSS Provider Portal and Generate the Enrollment Pre-Checklist

Step 2 covers PRSS Portal access and Pre-Checklist generation. Navigate to virginia.hppcloud.com. Click "New Enrollment." On the New Enrollment screen, PRSS presents the Enrollment Pre-Checklist requiring selection of: Enrollment Type (Individual, Group, IG, OPR), Provider Type, Specialty, Tax ID Type (EIN or SSN), Medicare-enrolled status (Yes/No, affects fee determination), and Programs accepted (FFS, Cardinal Care MCOs).

The Pre-Checklist generates a customized list of credentials and documentation required for your specific application. Capture the Pre-Checklist output and verify all listed documents are gathered before proceeding. The Pre-Checklist accuracy is your single best predictor of clean first-pass enrollment.

Step 3: Update Your CAQH ProView Profile (for Cardinal Care MCO Credentialing Preparation)

Step 3 covers credentialing data infrastructure. All 5 Cardinal Care MCOs (Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons in Virginia, Sentara Community Plan, UnitedHealthcare Community Plan) pull credentialing data from CAQH ProView. Self-register at proview.caqh.org. Complete every mandatory field.

Upload Virginia state license, malpractice declaration page, DEA Certificate (if applicable), board certificates, CV, W-9, and government-issued photo ID.

Authorize DMAS and each Cardinal Care MCO. Re-attest within 120 days per NCQA's Primary Source Verification standard. Our complete CAQH ProView management guide walks through every CAQH operational detail.

Step 4: Confirm License Status (Critical Post-July 2025 Rule)

Step 4 reinforces the most operationally critical 2025-2026 reality. Per the DMAS Bulletin effective July 1, 2025, DMAS eliminated the 90-day grace period following license expiration. License lapse equals immediate PRSS termination equals no Medicaid revenue.

Operational verification before PRSS submission: Verify active Virginia state license with the relevant Virginia licensing board. Confirm license expiration date is NOT within 60 days (to prevent mid-application lapse). Calendar all upcoming license renewals 90 or more days in advance. For multi-provider groups, audit license status of every NPI separately.

For multi-location providers, confirm license validity for each service location. Build a license renewal tracking system parallel to the enrollment workflow.

Step 5: Submit Your Certified W-9 and EFT Authorization

Step 5 covers payment infrastructure setup. Submit your IRS W-9 form with your Tax Identification Number (TIN). For individual providers, the W-9 must be in your name with your SSN and original signature. For groups or facilities, the W-9 must include the EIN and an original signature from an authorized representative.

Complete EFT Authorization with a voided check or bank verification letter. Per DMAS guidance, all Virginia Medicaid providers must receive payments via Electronic Funds Transfer (EFT). EFT is the only payment method available through Virginia Medicaid. Without EFT, no payments process. Name mismatches between W-9, application, and licenses are the single most common cause of PRSS application denials.

Step 6: Complete the Electronic PRSS Enrollment Application

Step 6 covers the core electronic enrollment application via the PRSS Provider Portal. Per DMAS policy, all initial provider enrollment applications must be submitted electronically through PRSS.

The electronic application requires: provider demographic and contact information, practice location addresses (must match physical operating location, not virtual addresses), Provider Type and Specialty, license information (license name, license number, and expiration date must exactly match Virginia licensing board records), taxonomy code, Cardinal Care MCO selection, and provider type-specific supplementary forms.

PRSS can forward selected enrollment documentation to Cardinal Care MCOs when you request participation.

Step 7: Verify PECOS Status (For Application Fee Determination)

Step 7 is uniquely Virginia in PRSS workflow. PRSS asks whether the service location is enrolled in Medicare. If "Yes," PRSS expects Medicaid enrollment attributes (provider type, specialty, ownership) to match Medicare via PECOS validation. Mismatches can result in the enrollment being returned (Return to Provider, or RTP) AND the application fee being required.

If you're already enrolled in PECOS, you may be exempt from the $750 CY 2026 fee under the "paid to another state" or Medicare-enrolled exemption pathways. PRSS workflow validates these exemptions automatically via PECOS query. Reconcile PECOS, NPPES, and PRSS attributes BEFORE submission to prevent RTP.

Step 8: Pay the $750 CY 2026 Federal Application Fee (Institutional Providers)

Step 8 applies only to institutional providers when no exemption applies. The CY 2026 federal application fee is $750 per CMS Federal Register Notice published December 3, 2025. Pay the fee at enrollment, when adding a new practice location, or at revalidation.

Virginia-specific: PRSS requires fee payment by credit card, debit card, or electronic funds transfer submitted with the online application. Hardship waivers and "paid to another state" exemptions can be claimed within PRSS workflow. Per the August 1, 2025 DMAS bulletin, pharmacies under specific provider class types are treated as institutional for the $750 fee. Provider Class Type 268-Pharmacist is exempt.

Step 9: Capture and Save Your Application Tracking Number (ATN)

Step 9 is the most often-overlooked critical step. After application submission, PRSS generates an Application Tracking Number (ATN) unique to your application. Capture this ATN immediately. Save it in your credentialing or RCM system the same day along with your password.

The ATN plus password combination is the key for all subsequent status checks via the Enrollment Status workflow. Without your ATN, status verification becomes manual and time-consuming. The Manage Revalidation Panel in PRSS shows in-process revalidation ATNs for base ID and locations where the user is an Authorized Administrator.

Step 10: Application Screening and Federal Database Verification

Step 10 triggers DMAS risk-based screening based on your provider type and risk classification. For ALL applicants regardless of risk level, DMAS verifies licenses through Virginia licensing boards, runs OIG LEIE exclusion checks, runs SAM.gov sanctions checks, and runs NPDB queries for adverse actions, malpractice payments, and clinical privilege restrictions.

DMAS reviews OIG LEIE on an ongoing basis after enrollment. Per Virginia Medicaid policy, any provider exclusion under OIG LEIE or SAM.gov must be self-reported to DMAS within 30 days. Per the MES Provider FAQ, standard enrollment processing typically takes up to 10 business days, with additional screening requirements extending handling time.

Step 11: Site Visit (Moderate and High Risk Providers Only) and Fingerprint Screening

Step 11 applies to Moderate and High risk providers. DMAS or its agents conduct pre-enrollment or post-enrollment unannounced site visits per 42 CFR §455.432 to verify information submitted is accurate and to determine compliance with federal and state enrollment requirements. The visit verifies the practice operates at the listed address as a working clinic, not a virtual address.

Site visit failures result in enrollment denials. High-risk providers also submit fingerprints for FBI criminal background checks coordinated through Virginia state agencies. Per the December 1, 2025 DMAS bulletin, new SNF and Hospice initial enrollments, re-enrollments, and changes of ownership are HIGH-risk requiring fingerprint screening. SNF/Hospice revalidations are MODERATE-risk requiring site visits.

Step 12: Receive Approval Notification and Initiate Cardinal Care MCO Credentialing

Step 12 delivers official enrollment confirmation. After approval, DMAS assigns your Virginia Medicaid Provider ID and sets your effective date. Per DMAS guidance, providers cannot bill for services rendered before the effective date.

Initiate separate Provider Agreement workflows with each Cardinal Care MCO you intend to contract with: Aetna Better Health of Virginia, Anthem HealthKeepers Plus (including Foster Care Specialty Plan if applicable), Humana Healthy Horizons in Virginia, Sentara Community Plan, and UnitedHealthcare Community Plan. PRSS can forward selected enrollment documentation to MCOs when you request participation.

MedSole expedites Virginia Medicaid enrollment at $99 per insurance with the fastest Virginia Medicaid enrollment approval timeline through continuous DMAS PRSS follow-up. Virginia Medicaid enrollment specialists handle the entire 12-step PRSS process plus all 5 Cardinal Care MCO contracting workflows simultaneously.

Pre-Enrollment Documentation Checklist for va medicaid provider enrollment

va medicaid provider enrollment through DMAS PRSS requires 20 to 25 distinct documents across six categories: provider identification (NPI, taxonomy), Virginia professional credentials (state license, board certification), practice documentation (W-9, EFT authorization), ownership disclosure (5-percent threshold), insurance and sanctions verification (malpractice, OIG LEIE, NPDB), and pathway-specific documents (DME, Pharmacy, SNF, Hospice, NEMT, Behavioral Health, FQHC).

DMAS rejects applications missing any required document via Return to Provider (RTP).

DMAS rejects applications missing any required document via Return to Provider (RTP).

NPI and Provider Identification Documents

Active NPI Type 1 (individual provider) registered in NPPES with taxonomy code matching specialty designation. NPI Type 2 (organizational) for group practices, hospitals, and facilities. Verify NPI status at NPPES public registry before PRSS submission. Solo practitioners affiliating with groups need both Type 1 and Type 2 NPIs.

Provider taxonomy code must match the specialty designation on the electronic enrollment application. Mismatches trigger immediate DMAS rejection via RTP. For IG and OPR enrollments, check the latest active provider extract first to avoid duplicate enrollment.

Virginia Licensing and Professional Credentials (Post-July 2025 License Compliance)

Virginia professional credentials documentation must match Virginia state records exactly. Active Virginia state license verified with the Virginia Board of Medicine (physicians), Virginia Board of Nursing (RNs/LPNs/APRNs), Virginia Board of Counseling (LPCs/LCSWs), Virginia Board of Pharmacy (pharmacists), Virginia Board of Psychology (psychologists), or the relevant Virginia specialty licensing board.

DEA Certificate (if controlled substances are prescribed). Board certification documentation (where required by specialty). CV with no unexplained gaps over six months.

Critical Virginia operational requirement (post-July 2025): license name, license number, and expiration date must exactly match Virginia licensing board records on the electronic enrollment application. License must be active. The 90-day grace period is gone. Lapsed license equals immediate PRSS termination.

Practice and Business Documentation

Practice documentation captures the business and ownership structure. Certified W-9 form with Tax Identification Number that matches IRS records (TIN mismatches cause federal database verification failures and trigger PRSS RTP). For individual providers, W-9 in your name with SSN and original signature.

For groups, W-9 with EIN and original signature from authorized representative. EFT Authorization with voided check or bank verification letter (EFT is the only payment method available through Virginia Medicaid). Practice address must match physical operating location, not virtual addresses. For group practices: Articles of Incorporation, Operating Agreement, or equivalent organizational documentation.

Ownership Disclosure and 5-Percent Threshold Documentation

Ownership disclosure captures the federal screening framework requirement. Per 42 CFR §455.104, every va medicaid provider enrollment must disclose every person with 5 percent or greater direct or indirect ownership interest plus any conviction or sanction history. For institutional providers and groups, disclosure of significant business transactions with sub-contractors and managing employees may be required.

Per 42 CFR §455.434, High-risk providers must submit fingerprints for every 5 percent or more owner. Ownership disclosure inaccuracies trigger immediate RTP and can extend enrollment by 30 to 60 days. Audit ownership records before submission.

Insurance, Sanctions, and Federal Database Documentation

Insurance and sanctions verification covers the federal screening layer. Malpractice insurance declaration page meeting Virginia Medicaid liability thresholds (specialty-dependent, generally $1 million per occurrence / $3 million aggregate). OIG List of Excluded Individuals and Entities (LEIE) self-check confirming no current exclusion. SAM.gov sanctions self-check. National Practitioner Data Bank (NPDB) self-query recommended pre-submission.

CAQH ProView re-attestation within 120 days per NCQA Primary Source Verification standard. Federal exclusion screening must continue every 30 days post-enrollment per NCQA 2026 standards.

Enrollment Pathway-Specific Documents (DME, Pharmacy, SNF, Hospice, NEMT, Behavioral Health, FQHC)

Specific enrollment pathways require additional documentation. DME suppliers: Virginia state licensure plus CMS-recognized accreditation; verify Medicare enrollment status given February 27, 2026 CMS Moratorium. Pharmacies: Virginia Board of Pharmacy licensure plus DEA registration; institutional fee applies per August 1, 2025 DMAS bulletin (except Provider Class Type 268-Pharmacist).

SNF/Hospice: HIGH-risk fingerprint screening per December 1, 2025 DMAS update for new enrollments, MODERATE-risk site visits for revalidations. NEMT: Virginia Department of Motor Vehicles registration, vehicle and driver documentation. Behavioral Health Agency: DBHDS licensure verification documentation. FQHC: HRSA designation documentation plus UDS reporting capability documentation.

Missing documentation is the most preventable cause of Virginia Medicaid enrollment delays via PRSS Return to Provider (RTP). DMAS rejects applications missing any required document, restarting the submission cycle. MedSole RCM's credentialing specialists audit every document before submission at $99 per insurance with the fastest Virginia Medicaid enrollment approval pathway through continuous DMAS PRSS follow-up.

Specialty Enrollment Pathways Under Virginia Medicaid DMAS

Seven specialty pathways require additional operational depth beyond the standard PRSS workflow. DME suppliers face the February 27, 2026 CMS Moratorium. Pharmacies carry the August 1, 2025 institutional fee rule. SNF and Hospice providers carry the December 1, 2025 risk escalation. Out-of-state telehealth providers carry unique Virginia reciprocal licensing requirements.

NEMT, FQHC, and behavioral health each carry distinct Virginia-specific documentation and compliance frameworks.

DME Supplier Enrollment and the February 27, 2026 CMS Moratorium

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers face a uniquely complex Virginia Medicaid enrollment environment in 2026. Per CMS guidance effective February 27, 2026, a CMS temporary enrollment moratorium for new DMEPOS suppliers in certain geographic areas applies to Medicare enrollment.

Virginia DMEPOS suppliers must verify their Medicare enrollment status before proceeding with PRSS enrollment, as Medicare enrollment status affects both PECOS fee determination and the $750 CY 2026 application fee exemption pathway.

Virginia DMEPOS enrollment through DMAS PRSS requires: Virginia Board of Health Professions licensure (orthotics and prosthetics), CMS-recognized accreditation (Joint Commission, ACHC, or HQAA for certain DME categories), Medicare enrollment documentation (or moratorium exemption documentation), five-year work history with no unexplained gaps, and EFT authorization.

"DMAS 97" refers to the DMAS-97 claim type used for DMEPOS claims in Virginia Medicaid. Review the Virginia DMAS provider manual for DMEPOS-specific billing codes and coverage criteria.

Pharmacy Enrollment and the August 1, 2025 Institutional Fee Rule

Per the DMAS Pharmacy Bulletin effective August 1, 2025, Virginia pharmacies enrolled under specific provider class types are treated as institutional providers for the $750 CY 2026 federal application fee. Notable exemption: Provider Class Type 268-Pharmacist is exempt.

Pharmacies face the full PRSS enrollment workflow: Virginia Board of Pharmacy licensure verification, DEA registration, NPI Type 2 (for the pharmacy entity), and EFT authorization.

Virginia Medicaid pharmacy claims route through the DMAS PRSS system and follow the DMAS Pharmacy Policy Manual for prior authorization, drug coverage criteria, and preferred drug list (PDL) compliance. The Virginia Medicaid PDL updates April 1, 2026 and July 1, 2026.

Pharmacy providers must verify drug coverage against the updated PDL at both dates. Preferred Drug List compliance affects prior authorization requirements for specific drug categories billed to Virginia Medicaid.

SNF and Hospice Provider Enrollment (December 1, 2025 Risk Screening Update)

Skilled Nursing Facility (SNF) and Hospice providers face the most operationally consequential specialty pathway in Virginia Medicaid enrollment in 2026. Per the DMAS Bulletin effective December 1, 2025, HIGH-risk screening applies to initial enrollments, re-enrollments, and changes of ownership. MODERATE-risk screening applies to revalidations.

SNF and Hospice providers must plan for fingerprint-based criminal background checks under 42 CFR §455.434 for the provider and any person with 5 percent or greater direct or indirect ownership interest. Site visits under 42 CFR §455.432 apply to both High and Moderate risk levels.

HIGH-risk processing typically extends enrollment timelines by 30 to 60 days. The $750 CY 2026 federal application fee applies to SNF and Hospice providers as institutional providers. Per DMAS guidance, SNF and Hospice providers must also maintain current CMS certification and Virginia Department of Health licensure aligned with PRSS enrollment.

Misalignment triggers automatic claim denials.

Out-of-State Telehealth Provider Enrollment

Out-of-state providers serving Virginia Medicaid members via telehealth must enroll in PRSS to receive reimbursement. Virginia Medicaid telehealth policy follows the permanent expansion framework established post-pandemic: synchronous audio-video telehealth is reimbursed at parity with in-person services for most covered services. Modifier 93 (audio-only behavioral health telehealth) and audio-only modifiers apply for eligible service categories.

Out-of-state providers must hold either a Virginia state professional license or a license from a state with Virginia reciprocal licensure recognition. The Virginia Board of Medicine's Interstate Medical Licensure Compact (IMLC) participation enables expedited physician licensure.

Telehealth providers must maintain Virginia PRSS enrollment active to bill any Virginia Medicaid member, regardless of the provider's physical location during the session. Verify telehealth coverage for your specific CPT codes against the DMAS fee schedule before enrollment.

NEMT Provider Enrollment

Non-Emergency Medical Transportation (NEMT) providers serve a critical Virginia Medicaid member population. Per DMAS guidance on how to become a Medicaid transportation provider in Virginia, NEMT providers enroll through PRSS with provider type selection for transportation services.

NEMT documentation requirements include: Virginia Department of Motor Vehicles vehicle registration for each transport vehicle, driver documentation (Virginia driver's license, background check clearance), vehicle inspection compliance, liability insurance meeting DMAS-required minimums, and EFT authorization.

NEMT providers must maintain compliance with Virginia DMAS NEMT policy manual requirements including trip documentation, authorization procedures, and mileage reimbursement rules. Virginia NEMT contracts often operate through a managed transportation broker model , verify broker contracting requirements alongside direct PRSS enrollment.

FQHC Enrollment

Federally Qualified Health Centers (FQHCs) in Virginia enroll through PRSS as institutional providers under DMAS. FQHC enrollment requires HRSA designation documentation plus UDS (Uniform Data System) reporting capability documentation. FQHCs receive the FQHC prospective payment rate from DMAS rather than the standard DMAS fee schedule rate.

Per DMAS guidance, FQHCs must also credential individually-rendering providers within the FQHC under the group's enrollment, using the Individual Within Group (IG) enrollment type for each practitioner. DBHDS licensing coordination applies to FQHC behavioral health services alongside PRSS FQHC enrollment.

Behavioral Health Agency Enrollment and DBHDS Coordination

Per DMAS guidance, behavioral health agency enrollment requires DBHDS licensure verification documentation aligned with PRSS enrollment. DBHDS licenses behavioral health agencies, certain residential providers, and developmental disability service providers. Effective DMAS enrollment requires both PRSS approval AND current DBHDS licensure.

Per the DMAS Bulletin on DBHDS licensing of Multisystemic Therapy (MST) providers, DBHDS licensure must be current and aligned with PRSS enrollment for behavioral health providers serving Virginia Medicaid members.

The CMP (Civil Monetary Penalty) Reinvestment Program provides funding for quality improvement initiatives affecting behavioral health providers serving Virginia Medicaid members with DBHDS coordination requirements. Telehealth RPM (Remote Patient Monitoring) expansion is available for qualifying behavioral health providers enrolled through PRSS with DBHDS licensure.

Virginia Medicaid Program Architecture: Cardinal Care, FAMIS, DD Waivers, and FCSP

Virginia Medicaid's program architecture has six components that every enrolled provider must understand. Cardinal Care serves most members. FAMIS serves children slightly above traditional eligibility. DD Waivers serve developmental disability populations outside MCO networks. The Foster Care Specialty Plan serves foster care, adoption, and aging-out youth.

Fee-for-service serves DD Waiver members and specific specialty pathways. DentaQuest serves dental care statewide separately from PRSS.

Cardinal Care Managed Care (October 2023 Unified Brand)

Cardinal Care is the unified Medicaid managed care brand DMAS launched in October 2023, merging the legacy Medallion 4.0 (families, children, expansion adults) and Commonwealth Coordinated Care Plus (CCC Plus, long-term care enrollees) programs into one program. Approximately 95 percent of Virginia Medicaid members receive services through Cardinal Care.

Providers contracting with Cardinal Care MCOs must be enrolled in PRSS first under the 21st Century Cures Act Section 5005 mandate.

Virginia has proposed budget amendments under H.R. 1 implementation increasing CHIP eligibility to 305 percent of federal poverty level and establishing a workgroup focused on mitigating coverage losses for children. These changes affect Cardinal Care and FAMIS enrollment volumes beginning late 2026 and continuing through 2027.

Provider revenue cycle impact: substantial patient eligibility churn beginning October 2026 (noncitizen eligibility changes) and January 2027 (retroactive coverage reduction).

FAMIS (Virginia's CHIP Under Cardinal Care)

FAMIS (Family Access to Medical Insurance Security) is Virginia's Children's Health Insurance Program (CHIP). FAMIS operates under the Cardinal Care umbrella. Children whose families earn slightly above traditional Medicaid eligibility but below the FAMIS income limit receive FAMIS coverage through Cardinal Care MCOs.

Providers enrolled through PRSS and contracted with Cardinal Care MCOs serve FAMIS members through the same MCO credentialing and billing workflows as Medicaid members. There's no separate FAMIS provider enrollment; PRSS enrollment and Cardinal Care MCO contracting covers both populations. FAMIS cost-sharing applies (modest premiums and copays for higher-income families).

Verify FAMIS benefit coverage for specific services against each MCO's FAMIS benefit documentation.

DD Waivers: Building Independence, Family and Individual Support, and Community Living

Virginia's three Developmental Disability (DD) Waivers are a critical carve-out from Cardinal Care MCOs. DD Waiver services are delivered exclusively through FFS Medicaid , not through Cardinal Care MCOs. This means DD Waiver providers bill DMAS directly rather than billing MCOs. Enrollment through PRSS is still required for DD Waiver providers, but the billing pathway is fee-for-service through DMAS.

The three DD Waivers serving Virginia Medicaid members: Building Independence Waiver (BI), serving individuals who live independently or with family without paid residential support; Family and Individual Supports Waiver (FIS), serving individuals living at home with family providing primary unpaid support; and Community Living Waiver (CL), serving individuals who need residential support and services in their community.

For DD Waiver provider enrollment, DBHDS licensure alignment with PRSS enrollment is required. DD Waiver members have unique service authorization requirements handled through DMAS directly rather than MCO prior authorization.

Foster Care Specialty Plan (FCSP) and Anthem HealthKeepers Plus Statewide Administration

The Foster Care Specialty Plan (FCSP) serves foster care children, adoption assistance recipients, and youth who have aged out of foster care up to age 26. Anthem HealthKeepers Plus administers the FCSP statewide across all Virginia localities.

Providers serving FCSP members must contract with Anthem HealthKeepers Plus directly for FCSP coverage. The FCSP uses a distinct credentialing and authorization workflow from the standard Anthem HealthKeepers Plus Medicaid contract. Providers should explicitly identify FCSP contracting needs during Anthem HealthKeepers Plus credentialing to ensure FCSP member claims process correctly.

PRSS enrollment is required before Anthem HealthKeepers Plus can complete FCSP credentialing per the 21st Century Cures Act sequencing mandate. Note that the "Fishing Point Healthcare Pause" (April 15, 2026) affecting certain behavioral health providers under FCSP illustrates why continuous PRSS compliance monitoring matters for specialty plan participants.

The Cardinal Care MCO Layer: All 5 Virginia Medicaid MCOs

Every Cardinal Care MCO operates a distinct provider credentialing and contracting workflow. All 5 require DMAS PRSS enrollment first. All 5 use CAQH ProView as primary credentialing data infrastructure. Each MCO has its own fee schedule, prior authorization rules, and timely filing windows.

Initiating all 5 MCO credentialing workflows simultaneously after PRSS approval is the fastest path to full Cardinal Care network participation.

Aetna Better Health of Virginia

Aetna Better Health of Virginia serves Cardinal Care Medicaid members and long-term care members under CCC Plus (now consolidated into Cardinal Care). Aetna Better Health of Virginia provider credentialing uses CAQH ProView for primary source verification. Aetna Better Health of Virginia's Provider Relations team manages contracting and credentialing separately from commercial Aetna.

Submit CAQH ProView authorization to Aetna Better Health of Virginia and request a provider contract specific to the Cardinal Care program. Aetna Better Health of Virginia has distinct prior authorization requirements from commercial Aetna. Verify PA requirements by service category before treating Cardinal Care members.

Anthem HealthKeepers Plus (Including Foster Care Specialty Plan)

Anthem HealthKeepers Plus is a Cardinal Care MCO serving both the standard Cardinal Care population and the Foster Care Specialty Plan (FCSP) statewide. BCBS Virginia provider enrollment routes through Anthem HealthKeepers Plus for Medicaid (Blue Cross Blue Shield of Virginia's Medicaid participation uses the Anthem HealthKeepers Plus network).

Anthem HealthKeepers Plus credentialing uses CAQH ProView and the Availity provider portal. Providers must explicitly identify FCSP contract participation needs at credentialing. Anthem HealthKeepers Plus maintains a separate fee schedule for FCSP versus standard Cardinal Care services. Prior authorization requirements vary by service category between FCSP and standard Cardinal Care.

Humana Healthy Horizons in Virginia (NEW July 2025 , Replaced Molina Healthcare)

Humana Healthy Horizons in Virginia joined Cardinal Care effective July 1, 2025, replacing Molina Healthcare which exited the Virginia Medicaid market. Providers who were contracted with Molina Healthcare for Virginia Medicaid must re-credential with Humana Healthy Horizons in Virginia. Humana Healthy Horizons in Virginia uses CAQH ProView for primary source verification.

Humana Healthy Horizons in Virginia's provider credentialing workflows follow the Humana Healthy Horizons enterprise model with Virginia-specific Cardinal Care adaptations. Contact Humana Healthy Horizons in Virginia provider relations directly to initiate credentialing under Cardinal Care. Legacy Molina Healthcare Virginia Medicaid contracts terminated July 1, 2025.

Former Molina Virginia providers must initiate Humana Healthy Horizons in Virginia credentialing if not already completed.

Sentara Community Plan

Sentara Community Plan (a product of Sentara Health Plans) serves Cardinal Care members across Virginia. Sentara Community Plan's provider relations team manages credentialing and contracting for Cardinal Care participation. Sentara Community Plan uses CAQH ProView as primary credentialing data infrastructure alongside its internal provider relations workflow.

Sentara Community Plan has particular strength in eastern and southeastern Virginia, including the Hampton Roads region. Sentara Community Plan prior authorization rules apply per the Cardinal Care program guidelines. Contact Sentara Community Plan provider relations to initiate credentialing and request a Virginia Medicaid Cardinal Care provider agreement.

UnitedHealthcare Community Plan

UnitedHealthcare Community Plan serves Cardinal Care Medicaid members across Virginia. UnitedHealthcare Community Plan's provider relations team manages credentialing through CAQH ProView and the Optum Provider portal (OptumCare's credentialing infrastructure). UnitedHealthcare Community Plan Virginia Medicaid maintains distinct prior authorization rules from commercial UnitedHealthcare products.

UnitedHealthcare Community Plan has particular strength in suburban markets and urban service areas across Virginia. Prior authorization management for UnitedHealthcare Community Plan Virginia Medicaid members routes through Optum prior authorization systems. Verify PA requirements for high-volume service categories before treating Cardinal Care members.

Initiating All 5 MCO Credentialing Workflows Simultaneously

After DMAS PRSS approval, initiating all 5 Cardinal Care MCO credentialing workflows simultaneously is the fastest path to full Cardinal Care network participation. CAQH ProView must be current and authorized for all 5 MCOs before any MCO credentialing can complete.

Update CAQH ProView attestation and authorize all 5 MCOs before submitting DMAS PRSS enrollment. MedSole RCM initiates all 5 Cardinal Care MCO credentialing workflows simultaneously alongside DMAS PRSS enrollment at $99 per insurance with the fastest Virginia Medicaid enrollment approval timeline through continuous DMAS PRSS follow-up.

Industry credentialing companies charge $150 to $300 per payer with passive timelines. MedSole RCM is the most affordable va medicaid provider enrollment partner with 99 percent first-time approval rate across more than 4,000 credentialed providers.

Realistic Virginia Medicaid Enrollment Timeline and 2026 Compliance Deadlines

va medicaid provider enrollment via DMAS PRSS takes 45 to 150 days depending on provider type, risk classification, and whether all documentation is complete at submission. The timeline below maps each phase to realistic duration expectations for 2026 enrollment.

Phase 1: Pre-Submission Preparation (Days 1-14)

Gather all required documentation per Section 7 checklist. Verify NPI status in NPPES. Confirm active Virginia state license (post-July 1, 2025 rule: no grace period). Complete or update CAQH ProView profile and authorize DMAS plus all 5 Cardinal Care MCOs. Complete W-9 and EFT authorization forms.

Verify PECOS enrollment status for application fee determination. For institutional providers, prepare $750 CY 2026 fee payment.

Typical duration: 5 to 14 days. Providers with up-to-date credentialing documentation complete this phase faster. Multi-location providers and group practices take longer due to per-location documentation requirements.

Phase 2: PRSS Application Submission and ATN Capture (Days 14-15)

Access the PRSS Provider Portal at virginia.hppcloud.com. Generate the Enrollment Pre-Checklist. Complete the electronic enrollment application. Submit with all documentation. Capture and save the Application Tracking Number (ATN) and password on submission day. Per the MES Provider FAQ, DMAS acknowledges receipt within 10 business days under standard processing.

New Manage Revalidation Panel operational note: if revalidating, the PRSS Manage Revalidation Panel now shows in-process ATNs for base ID and locations where the user is an Authorized Administrator.

Phase 3: DMAS Application Screening (Days 15-25 Standard, Days 25-75 With Site Visit or Fingerprint Screening)

Standard Limited-risk application screening: 10 business days from submission per MES Provider FAQ. Limited risk providers complete Phase 3 in 10 to 15 days. Moderate-risk providers add unannounced site visit scheduling: 14 to 45 additional days. High-risk providers add fingerprint-based criminal background checks: 30 to 60 additional days.

Per the December 1, 2025 DMAS bulletin, SNF and Hospice new enrollments are High-risk (30 to 60 days additional). PA turnaround shortened to 7 calendar days per the 2026 CMS Interoperability Final Rule (applies to PA decisions, not enrollment screening).

Phase 4: Cardinal Care MCO Credentialing (Days 25-90 After PRSS Approval)

After DMAS PRSS approval, Cardinal Care MCO credentialing workflows begin simultaneously for all 5 MCOs. Each MCO conducts independent primary source verification via CAQH ProView plus internal committee review. Typical MCO credentialing timelines: 30 to 90 days per MCO from application submission to effective date.

Credentialing processes happen in parallel when all 5 MCO applications submit simultaneously. Effective date for MCO billing cannot precede the DMAS PRSS effective date. Per the 21st Century Cures Act, MCOs are prohibited from reimbursing claims from providers without active PRSS enrollment.

Phase 5: Revenue Cycle Operational Launch (Day 90-150)

After all 5 Cardinal Care MCO effective dates are confirmed, configure billing system with each MCO's payer ID, fee schedule, PA rules, and timely filing windows. Set up EDI clearinghouse connections for each MCO. Configure EFT deposits via DMAS direct payment system.

Enroll in each MCO's provider portal for eligibility verification and PA submission. Implement eligibility verification workflows for H.R. 1 semi-annual re-determinations beginning late 2026. Set up PDL compliance monitoring for April 1 and July 1, 2026 DMAS Preferred Drug List updates.

Total Timeline Summary

The fastest path to PRSS approval starts with a complete documentation package on Day 1. Missing any required document triggers Return to Provider (RTP) which restarts the Phase 3 clock.

When to Outsource va medicaid provider enrollment

va medicaid provider enrollment is operationally expensive when done in-house.

The 12-step PRSS workflow, the 5-MCO Cardinal Care credentialing layer, the 7 critical 2026 compliance updates, the license renewal tracking system, the ATN status monitoring, the DBHDS coordination for behavioral health providers, and the continuous DMAS PRSS follow-up required to meet Virginia's fastest enrollment approval windows together consume 40 to 80 hours of staff time per provider.

Industry credentialing companies charge $150 to $300 per payer with passive 60 to 120 day timelines. The math for outsourcing is clear when staff cost, time-to-enrollment, and approval rate are compared against the MedSole RCM benchmark.

What In-House Virginia Medicaid Enrollment Actually Costs

Calculate the true in-house cost before deciding whether to outsource va medicaid provider enrollment. Staff time at $25 per hour for 40 hours per provider (minimum for a clean enrollment) equals $1,000 per provider in staff cost alone.

Mistakes cost more: one RTP (Return to Provider) rejection adds 10 to 30 additional business days and another 10 to 20 hours of staff time. One missed license renewal under the post-July 2025 rule costs the provider potentially months of locked-out billing across FFS and all 5 Cardinal Care MCO networks.

Industry credentialing companies charge $150 to $300 per insurance payer with no guaranteed approval rate and no continuous follow-up. For 6 enrollments (1 DMAS PRSS + 5 Cardinal Care MCOs), that's $900 to $1,800 per provider group at passive 60 to 120 day timelines.

MedSole RCM handles the entire va medicaid provider enrollment process at $99 per insurance with a 99 percent first-time approval rate and the fastest Virginia Medicaid enrollment approval timeline through continuous DMAS PRSS follow-up. For 6 enrollments, that's $594 total per provider group, including all 5 Cardinal Care MCO credentialing workflows initiated simultaneously.

What MedSole RCM's Virginia Medicaid Enrollment Service Covers

MedSole RCM's va medicaid provider enrollment service covers the full scope at $99 per insurance: PRSS portal access and Pre-Checklist generation, complete documentation audit before submission (preventing RTP), PECOS status verification and $750 CY 2026 fee pathway determination, ATN capture and status monitoring, and continuous DMAS PRSS follow-up until effective date.

Also included: CAQH ProView management for all 5 Cardinal Care MCOs and simultaneous initiation of all 5 Cardinal Care MCO credentialing workflows upon PRSS approval.

License renewal tracking is included: MedSole's credentialing systems calendar every license expiration 90 or more days in advance given the July 1, 2025 elimination of the 90-day grace period. One missed license renewal costs more than all of MedSole's enrollment fees combined.

No setup fees. No hidden charges. No annual contracts. The lowest structured pricing in the US RCM market. MedSole RCM is the most affordable va medicaid provider enrollment partner in the United States.

The 2.99 Percent of Collections Medical Billing Alternative

For Virginia Medicaid providers who also need billing and revenue cycle management beyond enrollment and credentialing, MedSole RCM's medical billing service operates at 2.99 percent of collections, which includes full claims submission, denial management, AR follow-up, and revenue cycle management for all payers. Industry billing companies typically charge 4 to 9 percent of collections for the same scope.

The combined $99 per insurance credentialing plus 2.99 percent of collections billing service delivers the most affordable Virginia Medicaid credentialing and billing combination in the US RCM market. Virginia providers typically recover the entire annual cost within the first 30 days of billing under the MedSole RCM service.

5 Signs You Need to Outsource va medicaid provider enrollment

Outsource va medicaid provider enrollment when: you've received an RTP rejection and don't know why; your application is more than 30 days past expected processing without ATN status updates; you're a new group practice with 3 or more providers needing simultaneous PRSS enrollment and 5-MCO credentialing; or you're a DME supplier or SNF/Hospice provider needing High-risk fingerprint screening coordination.

Outsourcing also makes sense for out-of-state telehealth practices seeking to become a Medicaid provider in Virginia without local administrative infrastructure.

MedSole's revenue cycle management service and AR follow-up service extend the enrollment foundation into ongoing billing operations for Virginia Medicaid providers at 2.99 percent of collections. Provider enrollment credentialing is the first step; revenue cycle management is the continuous operational layer that maximizes Virginia Medicaid reimbursement after enrollment.

The most affordable va medicaid provider enrollment partner handles the full PRSS workflow, Pre-Checklist generation, ATN tracking, $750 CY 2026 fee processing, SNF and Hospice High-risk screening coordination, and license renewal compliance under the July 1, 2025 grace period elimination.

MedSole RCM. No setup fees. No hidden charges. No annual contracts.

Virginia Medicaid Provider Enrollment Contact Reference

The Virginia Medicaid provider enrollment contact landscape covers three operational layers: DMAS and Gainwell Technologies for PRSS enrollment, Cardinal Care MCO provider relations for each of the 5 MCOs, and DentaQuest for dental enrollment.

DMAS and Gainwell Technologies PRSS Enrollment Contacts

The primary Virginia Medicaid provider enrollment contact is the Gainwell Technologies PRSS team operating on behalf of DMAS.

Virginia Medicaid Provider Enrollment Hotline: 1-888-829-5373 (toll-free) | 804-270-5105 (local) Hotline Hours: Monday through Friday, 8 AM to 5 PM Eastern

Virginia Medicaid Provider Enrollment Email:vamedicaidproviderenrollment@gainwelltechnologies.com

PRSS Provider Portal: virginia.hppcloud.com (Enrollment application, ATN status check, Manage Revalidation Panel)

MES Provider Hub: vamedicaid.dmas.virginia.gov/provider (Policy bulletins, provider manuals, fee schedules)

DMAS Main Website: dmas.virginia.gov (Policy, program guidance, DMAS fee schedule, DMAS provider manual)

The Virginia Medicaid provider enrollment phone number for PRSS-related inquiries (va medicaid provider enrollment phone number) is 1-888-829-5373 toll-free. Use 804-270-5105 for local calls. The va medicaid login for PRSS status checks routes through virginia.hppcloud.com using your ATN and password.

The MES login for FFS service authorization requests (effective April 27, 2026, mandatory June 1, 2026) routes through the DMAS MES portal at vamedicaid.dmas.virginia.gov with single sign-on via the Acentra ANG tile. For the virginia medicaid provider portal and dmas provider portal, both terms reference the PRSS system at virginia.hppcloud.com.

Cardinal Care Helpline: 1-800-643-2273 (for member eligibility verification and managed care navigation)

MediCall Eligibility Line: 1-800-884-9730 (real-time member eligibility verification for fee-for-service claims)

Virginia Medicaid Fraud Hotline: 1-866-486-1971 (report suspected fraud, abuse, or waste)

Cardinal Care MCO Provider Relations Contacts

Aetna Better Health of Virginia: Provider Relations Department, Aetna Better Health of Virginia, Richmond, VA. CAQH ProView authorization required before contact.

Anthem HealthKeepers Plus: Anthem HealthKeepers Plus Provider Services. Availity provider portal access (availity.com) for credentialing and prior authorization. FCSP contracting: contact Anthem HealthKeepers Plus provider relations directly and identify FCSP contract need explicitly.

Humana Healthy Horizons in Virginia: Humana Healthy Horizons Provider Relations, Virginia Cardinal Care (NEW July 1, 2025). CAQH ProView authorization required. Former Molina Healthcare Virginia Medicaid providers must initiate re-credentialing with Humana Healthy Horizons in Virginia.

Sentara Community Plan: Sentara Community Plan Provider Relations. Strong presence in Hampton Roads and southeastern Virginia. CAQH ProView authorization required.

UnitedHealthcare Community Plan: UnitedHealthcare Community Plan Provider Services (OptumCare network). Optum Provider portal for PA and credentialing management.

DentaQuest Dental Enrollment Contact

DentaQuest Enrollment Email:CredEnrollment@DentaQuest.comDentaQuest Dental Enrollment Phone: 800-233-1468

Dental providers do NOT use the PRSS Provider Portal. DentaQuest administers Cardinal Care Smiles, Virginia's statewide Medicaid dental program. Dental providers enroll directly through DentaQuest using the contacts above.

Member Enrollment Contacts (Disambiguation)

Patients seeking Virginia Medicaid member enrollment (not providers) contact Cover Virginia at 1-855-242-8282 or visit coverva.dmas.virginia.gov. Eligibility determination happens at the local Department of Social Services (DSS) office, not DMAS directly. This is a uniquely Virginia structural distinction. CommonHelp online applications: commonhelp.virginia.gov.

Frequently Asked Questions: Virginia Medicaid Provider Enrollment

The 15 questions below capture every verified Google PAA and Bing PAA question plus strategic operational questions Virginia providers ask most.

What is the va medicaid provider enrollment phone number? The Virginia Medicaid provider enrollment phone number for the DMAS PRSS Gainwell Technologies hotline is 1-888-829-5373 toll-free or 804-270-5105 local. Hours are Monday through Friday, 8 AM to 5 PM Eastern. Email: vamedicaidproviderenrollment@gainwelltechnologies.com.

How do I check my va medicaid provider enrollment status? Check your va medicaid provider enrollment status using your Application Tracking Number (ATN) and password through the Enrollment Status workflow at the PRSS Provider Portal (virginia.hppcloud.com). If you don't have your ATN, call the Gainwell PRSS hotline at 1-888-829-5373. The new Manage Revalidation Panel in PRSS shows in-process revalidation ATNs for base ID and locations where you're an Authorized Administrator.

What is the va medicaid provider portal? The va medicaid provider portal is the PRSS Provider Services Solution Portal operated by Gainwell Technologies on behalf of DMAS at virginia.hppcloud.com. Providers access the PRSS portal for initial enrollment, revalidation, ATN status checks, Enrollment Pre-Checklist generation, and the new Manage Revalidation Panel. The MES provider hub at vamedicaid.dmas.virginia.gov provides access to policy bulletins, provider manuals, and the FFS Service Authorization tile (mandatory June 1, 2026).

What is the va medicaid provider enrollment login? The va medicaid provider login for PRSS uses your ATN (Application Tracking Number) and password assigned at enrollment application submission. Access the login at virginia.hppcloud.com. For FFS Service Authorization, the virginia medicaid login uses your DMAS MES credentials at vamedicaid.dmas.virginia.gov via the Acentra ANG single sign-on tile (mandatory June 1, 2026).

What is the va medicaid provider enrollment form? There's no single static DMAS provider enrollment form. Virginia Medicaid provider enrollment uses an electronic application within the PRSS Provider Portal at virginia.hppcloud.com. The Enrollment Pre-Checklist generates dynamically based on your enrollment type, provider type, specialty, Tax ID type, Medicare enrollment status, and programs accepted. Complete the PRSS electronic application rather than downloading a static PDF.

What is DMAS provider enrollment? DMAS provider enrollment is the process by which Virginia healthcare providers register with the Department of Medical Assistance Services (DMAS) through the Provider Services Solution (PRSS) Portal to receive reimbursement for services provided to Virginia Medicaid members. DMAS provider enrollment is required for both fee-for-service billing and Cardinal Care MCO network participation per the 21st Century Cures Act Section 5005.

How do I start or resume my Virginia Medicaid provider enrollment application? Start a new Virginia Medicaid provider enrollment application at virginia.hppcloud.com by clicking "New Enrollment." Generate the Enrollment Pre-Checklist first. To resume an in-progress application, use your ATN and password at the Enrollment Status workflow. Call the Gainwell PRSS hotline at 1-888-829-5373 if you need ATN recovery assistance.

What is a provider enrollment application? A provider enrollment application is the formal submission a healthcare provider makes to a state Medicaid agency (in Virginia's case, DMAS via PRSS) to register for Medicaid reimbursement. The application includes provider identification (NPI, taxonomy), professional credentials, practice location, ownership disclosure, and payment setup (W-9, EFT). In Virginia, all provider enrollment applications submit electronically through the PRSS Provider Portal.

How do I enroll in Virginia Medicaid as a provider? To enroll in Virginia Medicaid as a provider: verify eligibility and gather documentation, generate the Enrollment Pre-Checklist at the PRSS portal (virginia.hppcloud.com), update CAQH ProView, confirm active Virginia license (post-July 2025 grace period eliminated), submit W-9 and EFT authorization, complete the electronic PRSS application, pay $750 CY 2026 fee if institutional, capture ATN, complete DMAS screening, complete site visit or fingerprint screening if Moderate or High risk, receive approval, then initiate all 5 Cardinal Care MCO credentialing workflows.

How do I enroll in a Medicaid provider training program? Virginia Medicaid provider training resources are available through the DMAS MES Provider Hub at vamedicaid.dmas.virginia.gov. DMAS publishes provider bulletins, policy updates, and training materials through the MES portal. Cardinal Care MCOs provide MCO-specific training for credentialed providers through their provider portals. Gainwell Technologies also provides operational training for PRSS portal navigation.

What happened to Molina Healthcare in Virginia Medicaid? Molina Healthcare exited the Virginia Medicaid Cardinal Care market effective July 1, 2025. Humana Healthy Horizons in Virginia replaced Molina Healthcare as the fifth Cardinal Care MCO effective July 1, 2025. Providers who were contracted with Molina Healthcare for Virginia Medicaid must re-credential with Humana Healthy Horizons in Virginia. Legacy Molina Virginia Medicaid contracts terminated July 1, 2025.

What is the $750 Virginia Medicaid enrollment fee? The $750 fee is the CY 2026 federal provider enrollment application fee established by CMS per the Federal Register Notice published December 3, 2025 under 42 CFR §455.460. It applies to institutional providers at first enrollment, when adding a new practice location, or at revalidation. Individual physicians, non-physician practitioners, and physician or therapy groups are exempt. Providers enrolled in Medicare or another state Medicaid/CHIP may claim exemption via PECOS validation through PRSS.

What is the MES single sign-on requirement for Virginia Medicaid? Per the DMAS Bulletin effective April 27, 2026, DMAS implemented MES single sign-on for FFS Service Authorization requests through the Acentra Health Atrezzo Next Generation (ANG) platform. A new "FFS Service Authorization" tile is available in DMAS MES for existing users with PRSS or AIMS access. Starting June 1, 2026, all providers must log in to FFS Service Authorization through MES single sign-on. Non-compliance disrupts authorization workflow and delays claims payment.

What is VA Medicaid enrollment (member)? Virginia Medicaid member enrollment (for patients seeking coverage, not providers) is a separate process from provider enrollment. Individuals apply through Cover Virginia at 1-855-242-8282 or commonhelp.virginia.gov. Eligibility determination happens at the local Department of Social Services (DSS). This guide covers provider enrollment. For member enrollment, contact Cover Virginia directly.

How does MedSole RCM handle Virginia Medicaid enrollment? MedSole RCM handles the entire va medicaid provider enrollment process at $99 per insurance with a 99 percent first-time approval rate and the fastest approval timeline through continuous DMAS PRSS follow-up. Services include PRSS Pre-Checklist generation, documentation audit, ATN tracking, and $750 CY 2026 fee processing.

MedSole RCM also handles CAQH ProView management and simultaneous initiation of all 5 Cardinal Care MCO credentialing workflows. MedSole RCM is the most affordable va medicaid provider enrollment partner in the United States. No setup fees. No hidden charges. No annual contracts. Contact MedSole RCM , your most affordable va medicaid provider enrollment partner , at medsolercm.com/provider-enrollment-and-credentialing-services.