Medical Payment Guidelines

Virginia Premier has developed medical policies that serve as guidelines for coverage decisions and assist with administering plan benefits. The policies express Virginia Premier’s determination of whether certain services are medically necessary, and they are based upon a review of currently available clinical information. These peer reviewed policies are used when no specific guidelines for coverage are provided by the Department of Medical Assistance Services of Virginia (DMAS) or by the Center for Medicare and Medicaid Services (CMS).  Medical policies are not a substitute for clinical judgement or for any prior authorization requirements of the health plan.  These policies are not an explanation of benefits. 

Medical policies can be highly technical and complex and are provided here for informational purposes. These medical policies are intended for use by health care professionals. The medical policies do not constitute medical advice or medical care. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. Virginia Premier members should discuss the information in the medical policies with their treating health care professionals.

Medical technology is constantly evolving and these medical policies are subject to change without notice, although Virginia Premier will notify providers as required in advance of changes that could have a negative impact on benefits. Additional medical policies may be developed from time to time and some may be withdrawn from use.  Medical policies that have become obsolete will be archived as appropriate. The medical policies generally apply to all Virginia Premier’s plans, although some variations may exist by plan type. Members may contact customer services representative for specific coverage information.

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@virginiapremier.com or by calling 804-968-1529.