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Cardinal Care Provider Pathways
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July 2, 2025
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Virginia Medicaid Launches Cardinal Care Health Plans and Member Options
RICHMOND -- Yesterday, Governor Youngkin and the Virginia Department of Medical Assistance Services (DMAS) announced the launch of the new Cardinal Care Managed Care program. Cardinal Care Managed Care is the largest Medicaid health program launch in Virginia’s history, affecting 1.4 million lives and prioritizing member-centered care that meets the diverse needs of Medicaid members across the Commonwealth. Cardinal Care Managed Care modernizes health care delivery and enhances the care and support provided to Virginians served by the program...
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Get to Know Our New Health Plan
How can Humana help members?
- Humana offers various resources including:
- Access to a variety of providers that members can search for here: Find Care | Humana
- 24/7 Wellness app (Go365)
- 24/7 Nurse advice/Crisis Line
- Dedicated care managers who will work with members or their caregiver on their healthcare needs
- Personalized member programs including Humana Beginnings (a maternity care management program) and Peer Support Programs
How do I contract with Humana or another MCO?
- If you have not contracted with Humana or if there is another MCO you wish to contract with, you can enroll via New Enrollment/MES portal and select Humana and any of the other Managed Care Organization (MCO).
- If you have not already done so, please reach out to begin the contracting process. Below are the relevant contacts based on your provider type:
- Please note, you will need to contract with Humana for continuity of care to continue beyond the 60 day grace period for your members. Providers who contract with Humana by August 1st will be given retroactive contracts to cover claims from July 1st.
How do I submit a claim with Humana?
- Claims can be submitted through Availity or mailed.
- You can use either the Humana or Medicaid ID to submit a claim.
- Claims must be submitted within 365 calendar days from the date of service.
- Corrected claims must be submitted within 180 calendar days from the date of the explanation of payment.
- When filing a claim providers should use Humana’s payer ID: 61101
Your Questions Were Answered!
 View a recorded Virtual Cardinal Care Member Education Session. Each recording includes the presentation given by DMAS and MCO representatives and question and answer portion of the event:
- Morning Virtual Cardinal Care Provider Education Session (June 13), watch here.
- Afternoon Virtual Cardinal Care Provider Education (June 13), watch here.
Watch a recording of the presentation without the question and answer portion or review a pdf of the presentation:
Submit additional questions about Cardinal Care Managed Care to DMAS. The Cardinal Care FAQ will also be updated with additional information based on the questions received.
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How to Check Eligibility
It's important for all Providers to check a member's eligibility each office visit/appointment to ensure the right services are covered, and also to decrease claim denials!
How to check the eligibility or claim status for a member:
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Use self-help service on the MES website. You can create an account if you don't have one by following the instructions on the page.
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Use the Virginia Medical Assistance MediCall System. (Learn how to use MediCall.) The MediCall System offers Medicaid providers 24/7 access to current member eligibility information, check status, claims status, prior authorization information, service limit information, pharmacy prescriber identification number cross reference, and information to access member eligibility and provider payment verification
Stay Connected With Us
Looking for more tips, health resources, and Medicaid updates? Stay connected by following us on social media!
Join our community on Instagram, Facebook, LinkedIn, and YouTube 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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