The Claims Department at Virginia Premier is committed to providing you with the highest level of service possible. Our mission is to pay claims correctly and quickly the first time. Doing it right the first time saves time and money for everyone. We want to help you improve the premier health outcomes of our members by reducing the time you spend on claims follow-up.

If you have questions for the Claims Department or suggestions on how we can improve our operations, please call us at 800-727-7536, press 4 for Claims. Our fax number is 804-819-5174.

Forms

All of our forms can be found in our Provider Forms library.

Claim Filing Addresses

Below is a list of claim filing addresses for Virginia Premier Medallion 4.0 providers:

  • PCP Claims
    PO Box 5550
    Richmond, VA 23220-0550
  • Specialty Claims
    PO Box 5550
    Richmond, VA 23220-0550
  • Hospital Claims
    PO Box 5550
    Richmond, VA 23220-0550
  • Transportation Claims
    PO Box 5287
    Richmond, VA 23220-0287
  • Claim Appeals
    PO Box 5286
    Richmond, VA 23220-0286

Can I use a copy of a form or one that has been printed in black ink?

No. Per the National Uniform Claim Committee (NUCC):

In order for the form to be read by a scanner, the form must be in red ink. The red ink that is specified for the form allows scanners to drop the form template during the imaging of the paper. This “cleaner” image is easier and faster to process with data capture automation such as ICR/OCR (Intelligent Character Recognition/Optical Character Recognition) software. Your vendor may choose not to process claim forms that are submitted in black ink.

Is the CLIA (Clinical Laboratory Improvement Amendments) certification number required on CMS 1500?

As of 6/15/13, Virginia Premier requires all providers performing lab services to submit a CLIA certificate number on both electronic and paper claims. The CLIA Certificate number should be populated in box 19 of the CMS 1500 form or in Loop 23 Segment REF X4 for electronic claims. Submitting a CLIA number is a federal requirement and failure to provide the require information will result in the denial of a claim and payment.

Can I fill out my claim form by hand?

  • No. All claims submitted must be computer generated or typed to ensure accurate processing. All required fields and appropriate procedure/diagnosis codes must be accurate on the claim form in order to be considered a clean claim.

Note: Handwritten claims are subject to be denied or returned.

What is considered a 'clean claim'?

  • A “clean claim” is defined as a claim that has no material defect or impropriety (including any lack of any reasonably required substantiation documentation) which substantially prevents timely payment from being made on the claim or with respect to which Virginia Premier has failed to timely notify the person submitting the claim of any such defect or impropriety.

Is the National Provider Identifier (NPI) Number required on all claims?

  • Yes, failure to include your NPI number on the claim could result in the claim being denied or rejected.

Is the place of service required?

  • Yes. All claims billed on a CMS form regardless of the provider type must have a valid place of service.
  • Failure to enter the place of service could result in the claim being denied or rejected.

How do I show the correct number of units when billing for rented durable medical equipment?

  • The number of units should always equal the actual number of days the equipment is rented. For example, when spanning dates of service such as, 11/1/13 – 11/30/13, the number of units should be “30”.
  • Please refer to the DMAS Appendix “B” for more information on billing units.

Do you accept electronic claims?

  • Yes. For more information, see the Electronic Claims Submission tab on this web page.

How do I file an appeal?

  • An Appeal is defined as a reconsideration of claims status.All denied claims must be appealed in writing to Virginia Premier within sixty (60) days of the original date of denial.
  • The “appeal claim” must include any supporting documentation, which explains or satisfies the reason for the original denial and why it should be paid accordingly.
  • Non-medical denials (e.g. timely filing, duplicate claim, cannot ID member, triage payment etc.) should be appealed to:
Virginia Premier
Attention: Claim Reconsideration Department
P. O. Box 5286
Richmond, Virginia 23220-0286

Claims denied for medical reasons (e.g. not medically necessary, etc.) must be appealed to Virginia Premier’s Medical Management Department with medical record documentation at:

Virginia Premier
Attention Medical Management Department
P. O. Box 5244
Richmond, Virginia 23220-0244

Some claim denials do not require an appeal and can be resolved by correcting the issue and simply refilling the claim. Examples include:

  • Not Authorized: Re-file the claim with the correct authorization number
  • Invalid or Expired CPT Code: Correct the code(s) and re-file the claim
  • Invalid or Expired Diagnosis Code: Correct the code(s) and re-file the claim
  • The Appeal Claims form can be accessed in the Claims section of the Provider Forms Library

If I make any contractual changes to my practice or business, what information do I need to provide to Virginia Premier’s Finance Department?

  • If you change your tax identification number, address, NPI #, legal business name or any other contractual changes please forward a W-9 along with your changes to your Contracting Representative immediately.
  • Doing this can avoid possible IRS regulated fines and/or withholdings from your claim, capitation and/or management fee payments.
  • In addition, any changes made without a W-9 attached will delay payment of any of your claims.

I need a copy of a previous months Capitation, Management Fee or Administrative Fee Detailed Report. Can I get a copy of that sent to me?

  • You can contact the Claims department at either 800-727-7536, option 4.
  • Unfortunately, due to ever changing enrollment data we may not be able to retrieve this information prior to 07/01/2007.

I only know my member’s information, what department do I contact to receive payment information?

  • You can contact the Claims department at 800-727-7536, option 4.

I would like to get my money directly deposited into my bank account, is that possible?

  • Virginia Premier offers Electronic Funds Transfer (EFT) and Electronic Remittances through our payment partner, Payspan. Sign up at:
  • providersupport@payspanhealth.com
    877.331.7154, Option 1
    Hours 8:00 AM – 8:00 PM ET
  • I already have EFT set up but I need to make changes to my bank account, what do I do?

  • Virginia Premier offers Electronic Funds Transfer (EFT) and Electronic Remittances through our payment partner, Payspan. Sign up at:
  • providersupport@payspanhealth.com
    877.331.7154, Option 1
    Hours 8:00 AM – 8:00 PM ET
  • I would like to have my Remittance Advice sent to me electronically, is that possible?

  • Virginia Premier offers Electronic Funds Transfer (EFT) and Electronic Remittances through our payment partner, Payspan. Sign up at:
  • providersupport@payspanhealth.com
    877.331.7154, Option 1
    Hours 8:00 AM – 8:00 PM ET
  • Why do all changes need a W-9?

    • The IRS requires us to submit accurate information to them each year.
    • Any changes to your provider information requires a current W-9 for IRS compliance.

    I do not have a W-9 already completed. Where can I find one?

    You can find a current blank W-9 on the IRS website.
    Clearinghouse Phone Website 837 Claims Professional 837 Claims Institutional 835 ERA






    Availity (800) 282-4548 https://www.availity.com/about-us/contact-us YES YES YES
    Change Healthcare (866) 371-9066 https://www.changehealthcare.com/support/customer-resources/enrollment-services YES YES YES
    RelayHealth (800) 527-8133 http://www.relayhealth.com/contact-us YES YES YES

    If you have questions for the Claims Department or suggestions on how we can improve our operations,

    • by phone at 800-727-7536 (press 4 for Claims)
    • by fax at 804-819-5174

    Virginia Premier CompleteCare (Medicare-Medicaid Plan) Providers

    Below is a list of resources to help with submitting claims:

    API Claims Submissions: CompleteCare– We want to make the process as easy as possible.  Learn about the portal and who to contact to get started here.

    Clearinghouses: CompleteCare– Virginia Premier is pleased to be partnering with two of the largest clearinghouses in the industry to provide a full range of electronic capabilities for our CompleteCare providers and network partners.

    CompleteCare Companion Guide– Instructions related to 837 Health Care Institutional & Professional Claims Transaction Based on ASC X12 Implementation Guides

    Virginia Premier Medallion 4.0 Providers

    Below is a list of Virginia Premier claim filing addresses:

    • PCP Claims
      PO Box 5550
      Richmond, VA 23220-0550
    • Specialty Claims
      PO Box 5550
      Richmond, VA 23220-0550
    • Hospital Claims
      PO Box 5550
      Richmond, VA 23220-0550
    • Transportation Claims
      PO Box 5287
      Richmond, VA 23220-0287
    • Claim Appeals
      PO Box 5286
      Richmond, VA 23220-0286

    EDI (Electronic) Claims Submission

    Virginia Premier strongly encourages our providers to file their claims electronically. By filing claims electronically, you are able to aid in lowering claims processing timeframes, which in turn allows Virginia Premier to make payments more quickly.

    EDI 837 Claims

    Please refer to the first document below for instructions on how to send EDI 837 (electronic) claims to Virginia Premier. You will find answers to most of your questions here: The EDI 837 (Electronic Claims Enrollment) form can be found in the Claims section of the Provider Forms Library.

    EDI 835 ERA

    Should you want to receive the EDI 835 ERA (Electronic Remittance Advice) from Virginia Premier, the process is exactly the same as the process to send electronic claims to Virginia Premier. Only the form is different. The EDI 835 (Electronic Remittance Advice) form can be found in the Claims section of the Provider Forms Library.

    Other EDI Transactions

    Virginia Premier also offers additional transactions in partnership with our clearinghouses. If interested in either of the following, please contact your clearinghouse.
    • 277 – Claim Acknowledgment
    • 997 – Functional Acknowledgment

    E-Mail: vphp_edi@vapremier.com

    Technical Support: edi_support@vapremier.com

    All of our forms can be found in the Claims section of the Provider Forms Library.