Medicare Member Resources

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Virginia Premier is here to help you find quality health care services. We offer members an excellent network of doctors, hospitals and other healthcare providers and a wide range of Medicare services.

If you can’t find answers to all of your questions, please contact us. We’re here to help. You can reach Member Services at 1-877-739-1370 (TTY: 711). From October 1 to March 31, we are open daily from 8:00 am to 8:00 pm, 7 days a week. From April 1 through September 30, we are open Monday through Friday, 8:00 am to 8:00 pm. On certain holidays and weekends from April 1 through September 30, your call will be handled by our automated phone system.

Plan
Documents

Find important information and forms.

Pharmacy
Benefits

Learn about your pharmacy benefits.

Member
Portal

Sign in to Virginia Premier’s Member Portal.

Provider / Pharmacy Locator

Find a doctor, specialist, or pharmacy near you.

Extra
Benefits

Learn about your extra benefits.

The Provider & Pharmacy Directories list the providers and pharmacies in the Virginia Premier network. 

What are “network providers”?
Network providers are doctors, nurses, and other health care professionals that you can go to as a member of our plan. Network providers also include clinics, hospitals, nursing facilities, adult day care facilities, personal care providers, respite care providers, medically appropriate therapies, and other places that provide health services in our plan. They also include home health agencies, medical equipment suppliers, and others who provide goods and services that you get through Medicare.

Using out-of-network providers
With few exceptions, you must pay for services you receive from providers who are not part of the Virginia Premier network unless Virginia Premier has approved these services in advance. The exceptions are care for a medical emergency, urgently needed care, out-of-area renal (kidney) dialysis services and services that are found upon appeal to be services that we should have paid or covered.

What are “network pharmacies”?
Network pharmacies are pharmacies (drug stores) that have agreed to fill prescriptions for our plan members. Use the Provider & Pharmacy Directory to find the network pharmacy you want to use. Except during an emergency, you must fill your prescriptions at one of our network pharmacies if you want our plan to help you pay for them.

For additional information regarding the Virginia Premier Medicare Advantage network, please see your plan’s Evidence of Coverage.

You will have certain rights, as well as responsibilities, as a member of a Virginia Premier Medicare Advantage plan. You can think of those rights and responsibilities as a type of agreement with us as part of our partnership for your health care. We also have information for your rights upon disenrollment.

If you believe you have qualified for Extra Help (also called low-income subsidy (LIS) level) and you believe that you are paying an incorrect cost-share amount when you get your prescription(s) at a pharmacy; Virginia Premier has established a process that allows you to provide the evidence you already have to us. 

You can provide us one of the following:

  • A copy of the Medicaid card with the member’s name and an eligibility date;
  • One of the following letters from Social Security Administration showing Extra Help and effective date:
    • “Important Information” Letter;
    • “Award” Letter;
    • “Notice of Change” Letter;
    • “Notice of Action” Letter

You may be asked to provide additional documentation if you are institutionalized.

To initiate the BAE review complete the Best Available Evidence Request Form or for further assistance please call Virginia Premier at 1-877-739-1370 (TTY: 711) or see the Centers for Medicare & Medicaid Services (CMS) website for more information.

Empowering a Healthier You

New Pharmacy Benefit Manager Coming In 2023

Virginia Premier is always looking for ways to improve your benefits and services. As of January 1, 2023, the Virginia Premier pharmacy benefit manager (PBM) will change from Elixir to Express Scripts, Inc. You will continue to get your covered

Read More

Resources

By logging in to this portal, I affirm that I have read, understand and agree to abide by the following terms and conditions: 

I certify I am a health care provider, an employee of a health care provider, a business associate of a health care provider, or an employee of a business associate, and the purpose of my access to any Virginia Premier System is related to the provision or payment of health care services.

With respect to all information viewed or obtained from this site, I agree to comply with all applicable federal and state laws regarding the confidentiality and integrity of health and medical records. This includes full compliance with the Health Insurance Portability and Accountability Act of 1996 (‘HIPAA’), the HITECH Act, and the Virginia Health Records Privacy Act, and applicable regulations to these laws.

I agree to keep confidential all information related to Virginia Premier System business, including, but not limited to, quality and risk management activities as well as other confidential or personal information concerning the medical, personal, or business affairs of Virginia Premier System and its members.

I agree to notify Virginia Premier System immediately in the event that my network access has been compromised in any way and in the event of unauthorized use or disclosure of any information obtained from the Virginia Premier System network.

Need to register for a new account? Click here.

In order to register for an account, if you would like access to all group NPIs/APIs under a single Tax ID, please enter your Tax ID only. If you would like access to a specific group NPI/API instead, please enter it in the field provided. 

For expedited registration, please provide a Claim number and the Total Billed Charges on the claim when creating your account.

You will receive an email within 3-5 business days with your username and temporary password.

Please call Technical Support for help with Virginia Premier’s Provider Portal at 1-877-814-9909 or email connect@healthtrio.com. 

Virginia Premier is offering EFT services through PaySpan.

Please click here to sign-up

If you have questions or need help please, contact our Provider Services department at vphpnetdev@sentara.com or by calling 804-968-1529.