Need Help? We Are Here!
We appreciate your dedication to providing quality health care access & services to our members! We are here to assist you in finding information, training, and the resources you need.
Claims and Billing
Did you know the #1 Fee-for-Service claim denial reason (code) is edit 453 Enrolled in MCO? It's very important that you check a member's eligibility each time you see them for an appointment! A member's eligibility status, program type, or Managed Care Organization enrollment may have changed since their last visit! Ensuring the correct eligibility can help decrease denied claims.
DMAS provides Providers two self-service systems to check Member eligibility, FFS check amounts, service authorizations, and service limits.
- Verify the member's eligibility by using the MediCall automated phone system at 1-800-884-9730, or 804-965-9732.
- Verify the member's eligibility through the Virginia Medicaid web portal (MES). From this page, click the blue login button, use your secure credentials to sign in, select PRSS Portal, and then access the Eligibility tab.
Keep in mind that the possession of a card does not necessarily mean the holder is currently eligible for benefits.
If you have billing and claims questions, please contact Virginia Medicaid Provider Helpline at the toll-free (800-552-8627) or in-state (804-786-6273) phone numbers. We encourage you to contact the Provider Helpline prior to submitting an appeal.
If you have Cardinal Care Managed Care billing/claims questions, please visit our website.
Have additional questions, please check out more Provider Resources
The Provider (PRSS) portal has resources you need to get the help provide for our Members' health care! From training resources, enrollment, and checking your status, manuals, memos, and bulletins; it's all there! Please visit our Medical Enterprise System (MES) site for more information.
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Before Your Patient Leaves the Office, Have Them Download the Cardinal Care App!
The Virginia Cardinal Care App is a convenient tool that helps Members manage their Medicaid benefits right from their phone! With the app, members can easily check their eligibility, view their benefits, find doctors, and much more—anytime, anywhere. It's designed to make managing their health care easier and more accessible.
How does it work?
- Easily compare health insurance plans side-by-side
- Enroll in a health plan that works for them
- Quickly find driving directions to nearby providers, hospitals, specialists, and more
- En Español
Encourage them to download the app today to stay connected and in control of their health care journey!
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The app has easy-to-use functions to help members find providers like you!
Learn How to Advise Members on Changing Their Healthcare Plan
Medicaid is shaped by both federal and state laws, which can be complex. We know that navigating these rules can be challenging for our members. That's why we're dedicated to providing clear information to help members understand their Medicaid benefits and services.
We Care About Your Patients & Their Baby's Health!
Becoming a new mother is a life-changing experience, full of excitement and challenges. One of the most important aspects of a new mother's health is making sure she has access to the care and support she needs in the months following childbirth.
In Virginia, Cardinal Care provides 12-Months Postpartum Continuous Coverage for women enrolled in Medicaid, ensuring new mothers can continue to receive the healthcare services they need throughout their first year postpartum. This extension of coverage is an essential step in ensuring the health and well-being of both mothers and their newborns.
Cardinal Care allows women who are enrolled in Medicaid and Family Access to Medical Insurance Security (FAMIS MOMS) to continue receiving medical care for a full year after childbirth. This extended coverage ensures that mothers don't face gaps in healthcare when their pregnancy-related benefits expire. Instead, they can maintain consistent access to critical health services that are vital during the postpartum period.
For more information and resources, visit the Cardinal Care website.
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Share the Impact of Your Care
We know your work changes lives, and we want to celebrate the difference you make in your patients' lives every day. Do you have a success story about how Medicaid has helped one of your patients achieve better health outcomes?
Share it with us by completing the short survey below for a chance to highlight the impact of Medicaid on the community.
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Stay Connected with Us in 2025
Looking for more tips, health resources, and Medicaid updates? Stay connected by following us on social media!
Join our community on Instagram and Facebook for the latest news, inspiring stories, and helpful tools to make the most of your benefits.
Please bookmark or favorite the Cardinal Care website.
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