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.
Claims 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 - Claim Appeals
PO Box 5286
Richmond, VA 23220-0286
Electronic Claims
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:
- How to Send EDI (Electronic) Claims to Virginia Premier
- List of Clearinghouses Contracted with Virginia Premier
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
EDI Clearinghouses
Clearinghouse | Phone | Email | 837 Claims Professional | 837 Claims Institutional | 835 ERA |
|---|---|---|---|---|---|
Availity | 800-282-4548 | support@availity.com | YES | YES | YES |
Change Healthcare | 866-371-9066 | https://www.changehealthcare.com/support/customer-resources/enrollment-services | YES | YES | YES |
RelayHealth | 800-527-8133 | DBQTSHInsuranceSupport@RelayHealth.com | YES | YES | YES |
If you have questions for the Claims Department or suggestions on how we can improve our operations, contact us:
- by phone at 800-727-7536 (press 4 for Claims)
- by fax at 804-819-5174
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
Frequently Asked Questions
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.
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
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
