Virginia Premier Elite Plus (CCC Plus / MLTSS)

Provider Resource Tool

Important Contact Information

Provider Services

1-877-719-7358

MLTSS Call Center

1-877-719-7358 Option 2 then

Option 2

Claims Customer Service

1-877-719-7358

Case Management

1-877-719-7358

Chronic Care Management

1-866-243-0937

Nurse Advice Line

1-800-256-1982

Behavioral Health Authorizations (Beacon)

BH Intensive Outpatient Program Requests

(ARTS)

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Community Mental Health Rehabilitation

Services (CMHRS)

LTSS Authorizations

No Prior Authorizations List at:

virginiapremier.com/providers/medicaid

Phone numbers:

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LTSS Requests, contact the Care Coordination

or fax 1-877-739-1365

How to Check Eligibility

Since a member’s eligibility can change month-to-month, please verify your patient’s ID card and eligibility

every visit. Providers can use one of three options to verify member eligibility:

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Virginia Premier Provider’s Portal: virginiapremier.com/providers/medicaid

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Calling Virginia Premier directly at 1-877-719-7358

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Calling the CCC Plus Helpline at 1-844-374-9159

▪ Submit CMS 1500 Claims Forms

▪ Check Member Eligibility

▪ Check Claims Status

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Send paper submissions to:

Virginia Premier Elite Plus

PO BOX 4369

Richmond, VA 23220-8369

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Electronic Submissions

▪ Payer ID 837 Professional: 1244

▪ Payer ID 837 Institutional: 4573

▪ Phone Number: 1-800-981-8601

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Electronic Funds Transfers (EFT) and Electronic Remittance Advices (ERA) are issued through PaySpan.

Contact providersupport@payspan.com or 1-877-337-7154, option 1 for registration assistance.

Coordination of Benefits

Services Being Billed Primary Insurance Billing Instructions

MLTSS Waiver Services

Virginia Premier D-SNP

All Other Services Virginia Premier D-SNP

Another D-SNP Payer/

Other TPL Coverage

Medicare FFS

▪ Include of primary EOB

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For EDI submissions

▪ Create or forward claims in full HIPAA standard format (837) and include electronic payment

information received from the primary payer’s HIPAA standard electronic remittance advice (ERA).

Claim Reconsiderations

All reconsiderations must be submitted in writing on the Virginia Premier Claim Adjustment form via mail

within 60 days of the provider remittance date. For questions please contact Claims Customer Service at

1-800-727-7536.

education sessions at no cost.

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Members, Caregivers, and Providers can schedule non-emergent transportation by calling

1-877-719-7358, option #2

Pharmacy

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Virginia Premier Elite Plus covered prescription and over-the-counter drugs are administered through

Envision Pharmaceutical Services (Envision Rx), envisionrx.com. In addition to claim adjudication, Envision

Rx performs our Medication Therapy Management Program.

▪ In writing by either faxing 1-866-250-5178 or mailing to:

Envision Pharmaceutical Services, LLC

Attn: Coverage Determinations Dept.

2181 East Aurora Road

Twinsburg, OH 44087

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Implantable Contraceptive Devices

To obtain implantable contraceptive devices for Virginia Premier Elite Plus non-dual (i.e., not eligible

for Medicare Part D) members, you may use the order forms found on our website VirginiaPremier.com

or contact the preferred specialty vendor as directed below:

Virginia Premier Partners

Labs (except for CLIA approved

labs on the in-office lab list)

Routine Vision VSP: 1-800-877-7195

Dental (Smiles for Children and

MLTSS Enhanced Benefits)

Pharmacy Retail and Specialty Envision: 1-855-872-0005

Radiology (CT, CTA,CCTA, MRI,