Updates to Chapter II of All Provider Manuals

The Virginia Department of Medical Assistance Services (DMAS) issued a memorandum effective November 5, 2026, updating Chapter II of All Provider Manuals for all providers and Managed Care Organizations (MCOs) participating in the Virginia Medicaid program. The updates address billing requirement clarifications, provider enrollment obligations, and appeals procedural changes. On billing requirements, the revised Chapter II reaffirms that all medical providers must bill Virginia Medicaid or the appropriate contracted MCO for covered services furnished to eligible Medicaid members. The revisions explicitly prohibit providers, their vendors, and billing agents from seeking reimbursement from non-health insurance plans or carriers, including vehicular insurance (Medical Payments Coverage or Liability Coverage), property insurance, or funds associated with a Medicaid member's tort claims, for services covered by Medicaid. DMAS grounds this prohibition in Medicaid's payor of last resort requirements. On provider enrollment, DMAS states that under federal rules, MCOs and DMAS are prohibited from paying claims to network providers who are not enrolled in the Provider Services Solution (PRSS) portal. Providers must periodically check PRSS to ensure that enrollment, contact information, and license information are current for all service locations. Dental providers are directed to enroll directly through the DMAS Dental Benefits Administrator, DentaQuest. On appeals, the Virginia General Assembly directed DMAS in 2025 to promulgate regulations requiring providers to file appeals online. Those regulations took effect November 5, 2026, and Chapter II has been revised to conform. Providers must register for the Appeals Information Management System (AIMS) to file new appeals, upload documents, and track appeal status, as required by both the regulations and the Manual update.