[{"_1":2,"_100":-5,"_101":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6551582,"mediaKeyId","5332579-97c7a2ec6e47f608ed7a0d9d280c7e3f","parentId",5332579,"title","Providers told how to enroll, credential and contract for CCMC; plans list claims timing, remittance tools and training","audioSeconds",3044,"startMs",717770,"endMs",3762255,"viewUrl","/Search/View?dp=1&key=5332579-97c7a2ec6e47f608ed7a0d9d280c7e3f&start=717&end=3762","thumbnailUrl","https://assets.pipeline.soar.com/5332579-97c7a2ec6e47f608ed7a0d9d280c7e3f/thumbnail_717770.jpg","articleUrl","/articles/6551582/Virginia/Providers-told-how-to-enroll-credential-and-contract-for-CCMC-plans-list-claims-timing-remittance-tools-and-training","mediaUrl","https://secure.pipeline.soar.com/6551582-c97747208d135fc02b445d0e9688e629/orig.mp4?Expires=1771046203&Signature=HkE~TjM1cwIdpb9ThLLdSZ1vV-s~xwSyz36eTdNRnx50TvFGQbsSaO4TKGfi-LxqMReHUiY6-eMYyloNGq8ky1pHSHqeA0I1yCPbHQOCl4OoVrdYBD3OttlZwhmY3JsvOF6d4691kzERarQfYOipSxUbfaM3-EyVb6yBWs17qPJKMkqEKki5zEpX8b~qRpOEd74OkbhURBdzvaPXbvUKJs~SkJcVcv6M9LZ4i6lAgnCE5P4ZtU5dDA-IOrG4DQHB5a0oJgiiVZEcs~9Iy1-Bx3kwEFL49HIm67-kuFYpkBET6LZI7EbY9afzcQ-3NAlgRCv9b2dzY1QxJgjKpPoFJA__&Key-Pair-Id=KUT5TJCACFTXG","author","Cardinal Care is Virginia's Medicaid Program","date","2025-06-17T21:08:19Z","article","DMAS reiterated that providers must be enrolled with the state through the Provider Services Solution (PRSS) portal to participate in Cardinal Care. Speakers from Aetna, Anthem, Humana, Centerra (Sentara) and UnitedHealthcare said providers who are already in-network with an MCO do not need to re-enroll for CCMC; providers who wish to join additional MCOs must complete MCO contracting in addition to PRSS enrollment.

Aetna Better Health of Virginia said it uses Availity for claims and authorizations and that most providers can submit authorizations through Availity, although certain behavioral-health and LTSS provider types may use other forms. UnitedHealthcare, Humana and Centerra described their portals and credentialing tools (OnBoardPro, Availity, provider-specific portals) and said they offer virtual training sessions, weekly orientations or one-on-one onboarding for new or existing providers.

Humana staff said credentialing typically averages about 30 days and that contracts signed prior to Aug. 1 will be backdated to July 1. Humana and other plans asked providers to initiate contracting via plan-specific intake routes (medical, behavioral health, HCBS) and to use the MCO-provided contact lists; DMAS said it will compile and share a consolidated MCO directory and frequently asked questions.

On claims and payment cadence, plans gave different schedules: Aetna said it currently runs check/payments three times a week and is implementing daily quick-pay for certain safety-net provider types; Anthem said twice weekly; Humana, Centerra (Sentara) and UnitedHealthcare said they process claims daily. Humana reminded providers that initial claims must be submitted within 365 days of the date of service and corrected claims within 180 calendar days (Humana-provided portal guidance).

Multiple plans emphasized provider relations contacts, dedicated network educators and provider service teams for help with credentialing, claims escalations and onboarding. DMAS and the MCOs said they will post provider liaison and contract-manager contact information and training calendars on the DMAS Cardinal Care provider page and in plan portals.","mediaType","Video","parentTitle","Provider Q/A (Morning) Session for the New Cardinal Care Managed Care (CCMC) Program","oneSentenceSummary","DMAS and the five Cardinal Care MCOs reviewed steps for provider enrollment through PRSS, MCO credentialing and contract execution, credentialing timelines, claims submission rules and payment cadence. Plans offered provider portals, training calendars and contact pathways.","taxTitle","Department of Medical Assistance Services, Executive Agencies, Executive, Virginia","taxId",36421,"location","Virginia","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6551587,"Molina members move to Humana Healthy Horizons July 1; plans, DMAS say prior authorizations and waivers honored during transition",6574,414090,6988515,"/Search/View?dp=1&key=5332579-97c7a2ec6e47f608ed7a0d9d280c7e3f&start=414&end=6988","https://assets.pipeline.soar.com/5332579-97c7a2ec6e47f608ed7a0d9d280c7e3f/thumbnail_414090.jpg","/articles/6551587/Virginia/Molina-members-move-to-Humana-Healthy-Horizons-July-1-plans-DMAS-say-prior-authorizations-and-waivers-honored-during-transition","https://secure.pipeline.soar.com/6551587-1da01b51eda4b7df06676dcb311e539f/orig.mp4?Expires=1771046203&Signature=j5Hsq1QzRYg-Xox5j6oN0FdxlOQQEBWZyjNl8x7~8sioosG6xT33xxl697CHAlaUreBPLtnSxAFX~qG0W~KGka81sGcJDsOve9~uBNkkJZ6GHdubv~59p0v5LijElZ~CkUKeFpLjviGDE7uUNY04X6TtHFAzodflobDnO1oLs3avif6lGQv3Fqb-ba1lsPvcUKrdw3TDssjjl7vipT85s8qkFNoIejbL3Pa-ycTveFd~yGELzM438awoX-gPvHyXAQjwal4K1~Ni9B7lOMMLRONZzFcAzAkBGGbKRgbYl-Yjk1YaW8hXNmXugak-zhP3QDy4-X6ry9Dz92C4jByDkA__&Key-Pair-Id=KUT5TJCACFTXG","Humana Healthy Horizons in Virginia will receive Molina Medicaid members and accept Molina-issued service authorizations during a continuity period, Humana and DMAS representatives said during a June provider Q&A.

Carrie Whitaker, Humana’s director of contract compliance, said Humana will automatically enroll Molina members to Humana effective July 1, 2025, and will provide a 60-day continuity-of-care period during which existing prior authorizations will be honored and members may continue to see existing providers. Humana said it has been exchanging information with Molina to support the transition and will work with providers if they wish to join Humana’s network after the continuity period.

DMAS staff and other speakers clarified the transition schedule: Molina members are expected to be enrolled into Humana with an effective date of July 1, and members moved to Humana will have 90 days from that effective date to make any plan changes before standard open-enrollment rules apply. A DMAS representative confirmed during the session that the continuity-of-care period for authorizations in this transition is 60 days; earlier slides in the presentation had stated 30 days but the Q&A clarified the longer period.

On claims handling, DMAS staff said claims for Molina members with dates of service prior to July 1, 2025, should be submitted to Molina within Molina’s current timely-filing requirements. Elizabeth Smith of DMAS’s integrated care division said Molina will continue to process Virginia Medicaid business after June 30 and will complete outstanding claims and business for dates of service before July 1.

Providers with outstanding Molina claims that remain unresolved were told they may contact DMAS escalation channels (the CCC Plus mailbox was referenced) if plan-level resolution is unsuccessful. Humana said eligibility and claims visibility for transferred members generally will become available in plan systems after June 19, when assignment in the eligibility system occurs.","Humana and DMAS said Molina Medicaid members will be assigned to Humana Healthy Horizons effective July 1, 2025. Humana and DMAS clarified a 60-day continuity-of-care period for existing authorizations; Molina will continue processing prior claims for dates of service before July 1.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6551590,"Virginia launches Cardinal Care (CCMC) July 1; special enrollment, foster-care specialty plan, model-of-care changes explained",3,3440,7195,"/Search/View?dp=1&key=5332579-97c7a2ec6e47f608ed7a0d9d280c7e3f&start=3&end=7","https://assets.pipeline.soar.com/5332579-97c7a2ec6e47f608ed7a0d9d280c7e3f/thumbnail_3440.jpg","/articles/6551590/Virginia/Virginia-launches-Cardinal-Care-CCMC-July-1-special-enrollment-foster-care-specialty-plan-model-of-care-changes-explained","https://secure.pipeline.soar.com/6551590-2c302c0e0284c6809fd92845804249f3/orig.mp4?Expires=1771046203&Signature=GBszWo84TraXCTba3xF8OpHM~RNOf3XLfr4vX4IXdfepoeL3ArUeGgD22r-6X2S0RuLqd3ks0wwXK2cZKv21FkYaqbzgSo17V-LvuP~V8VpuW7JlsWqgxe5Kqubnj1-v~19RDRSwXKzmxhFMA-QqxCqcf7bRzl4gu4dKvfoArrRgYYKAIQ63PPJSyzVXZFJzBp0RXsjGOzQffH1DCqpGRTEI4iOpnEDH7TvO~ZNfLySh63ZtKsRyYlxJr3LrZAHJJCevHx2nxY5HCIdgWLw3JtPrc6bMIlH1Hv~rBq6zaixYiVid48f7JmwY1CN5UOx70bBAiS~~uoWgho0JibBaKA__&Key-Pair-Id=KUT5TJCACFTXG","The Department of Medical Assistance Services (DMAS) said Cardinal Care Managed Care (CCMC), a reprocurement and consolidation of Virginia’s Medicaid managed care program, goes into effect July 1, 2025, and will not reduce covered benefits or change the populations eligible for Medicaid.

DMAS facilitator Michelle Watts said the program consolidates previously separate managed care waivers and contracts and adds a stronger, member-centered model of care that emphasizes interdisciplinary care teams, tiered care-management intensity (low, moderate and high) and greater coordination of medical and nonmedical needs such as housing and food access. Watts also summarized the department’s top goals for Cardinal Care, including improved provider access, reduced administrative burden and a foster-care specialty plan.

The foster-care specialty plan will be operated statewide by Anthem HealthKeepers Plus for children and youth in foster care, adoption-assistance cases and individuals with former-foster-care eligibility, DMAS and Anthem representatives said. Anthem said the specialty plan will provide dedicated care-management supports for medical and behavioral needs and tailored benefits for youth in foster care.

DMAS said a special CCMC enrollment period runs June 19–Sept. 30, 2025, during which members may compare plans and select a managed-care organization (MCO). Members who do not select a new plan will remain in their current plan as of July 1. Molina members who move to Humana Healthy Horizons will be enrolled effective July 1 and have a 90-day window from that date to change plans, DMAS staff and Humana said.

DMAS and MCO speakers stressed there will be no reductions in covered services and that existing service authorizations will be honored during an initial continuity period. Humana and DMAS clarified during the Q&A that continuity of care for prior authorizations in the Molina-to-Humana transition will be 60 days; the slide deck had earlier stated 30 days, and DMAS acknowledged and clarified the longer period during the session.

Providers were told they must remain enrolled with DMAS through the state’s PRSS (provider services solution portal) and may need to contract with up to five MCOs to participate fully across the program. DMAS staff and the MCOs said provider-facing materials, training schedules, contact lists and the recording of the education session would be posted to the DMAS Cardinal Care provider page.

The session reiterated that Cardinal Care’s model of care is intended to make care coordination responsive to member needs rather than solely to eligibility category or diagnosis. DMAS pointed providers to the 2025 Cardinal Care managed-care contract posted on the DMAS website for details on the model of care (the contract’s model-of-care material begins at section 8).","The Department of Medical Assistance Services outlined the Cardinal Care Managed Care (CCMC) reprocurement, an updated model of care and a new foster care specialty plan that take effect July 1, 2025. DMAS and MCOs explained enrollment windows, continuity-of-care protections and provider resources during a June provider Q&A.","actionData","errors"]

Article not found

Providers told how to enroll, credential and contract for CCMC; plans list claims timing, remittance tools and training

Molina members move to Humana Healthy Horizons July 1; plans, DMAS say prior authorizations and waivers honored during transition

Virginia launches Cardinal Care (CCMC) July 1; special enrollment, foster-care specialty plan, model-of-care changes explained