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Questions?
You can call Provider Relations at 1-800-279-1878 (TTY: 711). We’re here for you Monday through Friday, 8 AM to 6 PM.
Why our network?
Why our network?
Whether you’re a physical or behavioral health care provider, we’ll work with you to understand your business and meet your needs.
When you take part in our provider network, you benefit from:
- Competitive compensation
- Ongoing support and learning opportunities
- Timely and efficient claims processing
- Advanced technology to help enhance patient care
- Dedicated support from us
Get all the answers you need from our communication materials, including the provider manual, newsletters and bulletins, emails, website notices, training kits and more.
We also help you:
- Track member information and updates
- Find forms
- Review claims or remittance advice
- Update changes to your practice
Your Provider Relations team
Your Provider Relations team
After you join our network, we’ll assign you a network consultant. They’ll be your primary point of contact with us, sharing important information with you. They’ll also help you with any administrative or operational concerns, like tracking member information and updates, finding forms and reviewing claims or remittance advice.
Your network consultant will:
- Share our administrative policies and procedures
- Communicate changes and updates that help you in the efficient administration of our plans
- Advocate on your behalf to resolve issues
- Manage changes to your demographic information
Our network consultants are based in the communities they serve, fostering personal relationships and a high level of responsiveness. They engage with providers in a variety of ways to provide proactive, prompt and collaborative communication.
You can also find answers in your provider materials, like your provider manual (PDF), notices and newsletters, training, emails and more.
Effective July 1, 2022, the provider enrollment process will be initiated through the Virginia Department of Medical Assistance Services (DMAS) instead of through the health plan.
Any provider not yet contracted with Aetna Better Health of Virginia or any Medicaid managed care organization (MCO) will first need to enroll with DMAS using their Provider Portal. DMAS will then alert Aetna Better Health of your request to join our network, and we will reach out to you with a contract package.
Start enrollment through the new PRSS enrollment wizard. Just visit virginia.hppcloud.com to get started. Only one enrollment application is necessary in PRSS. The application process allows for selection of multiple MCO plans. Once approved, your PRSS portal online account will be used to revalidate enrollment, make changes to personal or business information, and check member eligibility.
Find helpful training resources
Questions?
Contact the PRSS Provider Enrollment Helpline at 804-270-5105 or 1-888-829-5373 or email Provider Enrollment at vamedicaidproviderenrollment@gainwelltechnologies.com.
Qualifications that must be met for participation include:
- 24 hour/day, 7 day-a-week coverage
- A current, valid state license to practice medicine
- Staff privileges at a participating hospital
- An active DEA certificate (if applicable)
- Verification of medical school completion, residency training and fellowship
- Verification of board certification (in specialty being practiced)
- Current professional liability insurance that meets state minimum requirements
- Acceptable professional claims liability history, including the National Practitioners Data Bank (NPDB)
The Health Care Credentials and Data Collection Act requires uniform forms to be utilized in order to collect the credentials data commonly requested by health care entities and health care plans for purposes of credentialing and re-credentialing.
We are now accepting provider credentialing applications through CAQH Universal Provider Datasource (UPD). This system is a national provider credentialing application initiative from the Council for Affordable Quality Healthcare. The easy-to-use, streamlined database is the single repository of participating health plans for health care provider information, alleviating the need for physicians and other health care providers to complete and submit many different credentialing forms for multiple health plans, hospitals and other health care organizations. More than 300,000 providers are now reducing paperwork and administrative costs through the UPD.