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