Virginia Health Care Provider Resources
We know that you are busy, and having access to the latest Virginia health care tools and information is critical in today’s fast paced healthcare environment. So Virginia Premier decided to create an area dedicated to providing quick and easy access to the latest Virginia Premier provider communications and tools.
The Provider Manual is one of the many tools that Virginia Premier has available to make doing business with us easier. The Provider Manuals contain CompleteCare’s policies and processes on topics such as Member Benefits and Covered Services, Claims and Electronic Payments, Medical Management, Pharmacy Guidelines and much more.
Looking for the latest Virginia health care news and updates from Virginia Premier? The Provider Newsletter is just one of the ways we regularly communicate changes, updates and reminders to the provider network.
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2015
Summer 2015 July 2015.
- Winter 2015 February 2015.
Looking for the latest provider health care news and updates from Virginia Premier?
2016
- Provider Notice – VPCC Provider Portal Claims Submission
- Provider Notice – Balance Billing
- TDO provider letter 3-2-2016
- Provider Notice – VPCC Magellan Phone Number 2-10-2016
2015
We’re here for you! CompleteCare is building free online training modules and a library of literature to help give our providers the best possible resources to care for your patients.
CompleteCare Training
If you would like to attend an in-person training, our schedule can be found under the Education Meetings tab.
If you are looking for our “Nuts and Bolts” training, that can be found here.
If you have any questions about our training options, please contact us.
Some of the topics we offer training on:
- Cultural Competency
- Practice Accessibility
- Patient Safety
- Disability Literacy
- And many more great topics!
Looking for answers to your questions? CompleteCare has created a FAQ page with some of the most commonly asked questions from our providers.
Q: Who is eligible for Virginia Premier CompleteCare?
Eligible individuals include those who:
- Are 21 and older
- Are enrolled in full Medicare and full Medicaid
- Live in designated regions of Virginia serviced under the Commonwealth Coordinated Plan
Q: Is participation in Virginia Premier CompleteCare voluntary?
Yes, plan participation is completely voluntary. Members may decide not to join by opting out or withdraw from the program at any time and return to original Medicare and Medicaid coverage.
Q: How are members enrolled with a Virginia Premier CompleteCare?
Eligible members received a letter in 2014 which provides a phone number to call to sign up. A trained professional with Maximus, the enrollment broker hired by the State of Virginia, guides beneficiaries through the enrollment process. Individual health plans cannot enroll or dis-enroll beneficiaries directly.
Q: Do I need to check member eligibility?
Each new member enrolled with Virginia Premier CompleteCare will receive an individual member identification card. It is important to remember that a member’s eligibility could change on a month-to-month basis. Consequently, you should verify your patient’s eligibility each time they present for services. Providers can check member eligibility through several methods:
- Call Virginia Premier CompleteCare: 855-338-6467
- Check member eligibility with the CompleteCare Provider Portal
Q: Can my office staff and providers encourage members to select one plan over another?
No, this type of activity is prohibited by CMS. Providers are expected to remain neutral and should not encourage or sway members towards one plan or another. A provider may assist a beneficiary in an objective assessment of his/her needs and potential options to meet those needs. However providers should encourage members to call the plan’s enrollment broker, Maximus for assistance is selecting a plan.
Q: What are the benefits for a potential enrollee to enroll with one of the Commonwealth Coordinated plans?
- One ID card for members
- One toll free phone number for 24 hours/7 days a week assistance
- A unified appeals process
- Person-centered service coordination/case management
Q: What are the covered services to members enrolled Virginia Premier CompleteCare?
Benefits include all Medicare (part A, B and D) benefits and Medicaid benefits, including EDCD waiver services, nursing facility services and transportation.
Q: What types of Long Term Support Services are covered for the members enrolled in Virginia Premier CompleteCare?
Members have access to the following Long Term Support services, however all services must be pre-authorized.
- Adult Day services
- Respite Care
- Personal Care services
- Transition Coordination
- Personal Emergency Response services
- Transition Services
Q: Are there guidelines regarding out-of-network referrals for Virginia Premier CompleteCare members?
Referrals to non-participating specialists are permitted only if the required specialty service is not available through the Virginia Premier Health Plan network and the service is pre-authorized by the Plan. Out-of-plan referrals should be documented in the POC (Plan of Care) and agreed to by all ICT members.
Q: What if any benefits are carved out from this plan?
The following services are carved out:
- Case Management Services for participants of auxiliary grants
- Targeted case management for individuals with intellectual disabilities
- Community mental retardation services
Q: Can enrollees see providers who are out of network?
Yes, the plan must allow enrollees to maintain their current providers (including out-of-network providers) for 180 days from enrollment for new enrollees or for 30 days if the enrollee is switching from another CCC plan. However, after that period the plan must authorize any request to see an out-of-network provider.