Provider Forms Library

Are you a provider and looking for a specific Virginia Premier Elite form? Find forms quickly in our Provider Forms Library below.

  • EDI 837 (Electronic Claims Enrollment Form)
    In order to submit your claims electronically through a clearinghouse you must first complete and submit the EDI Enrollment form.
  • W9
    A completed W9 form should be sent for any legal name changes or Tax Identification Number Changes
  • Claim Adjustment Form
    Providers who want to appeal a claim outcome, need to submit a corrected claim, or request a retraction due to a payment error need to do so using the Claim Adjustment form.
  • Provider Refund Form
    The Provider Refund Form will assist Virginia Premier with handling your refund inquiries expeditiously. Please ensure all fields on the form are completed and attach detailed information explaining the reason for the refund.
  • Recruitment Request FormAre you a physician or healthcare provider interested in joining the Virginia Premier network? Please fill out the Recruitment Request form to request participation in the Virginia Premier network.
  • Provider Update Request Form
    Are you already a participating provider for Virginia Premier and need to notify us of updates or changes to your office or provider information such as address, phone numbers or providers? Please use this page to submit changes to Virginia Premier.
  • Panel Change Request Form
    Are you already a participating PCP and would like to close or open your member panel? Please use this form to notify Virginia Premier of your request.
  • Organizational Enrollment Application Form
    Download our organizational enrollment packet and application.

Medical Management


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 

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 or by calling 804-968-1529.