Medicaid Billing in Virginia

Palmetto GBA (JM). That contractor adjudicates Medicare claims for Virginia providers, publishes the local coverage determinations that bind you, and hears the first level of appeal. An argument that works with them works across every state they cover.

It runs as Cardinal Care, delivered largely through commercial managed care plans. So most Virginia Medicaid claims are adjudicated by an insurer with its own filing window, its own authorization rules, and its own appeal path — not by the state. Nationally about 78% of Medicaid beneficiaries sit in comprehensive managed care, and five companies hold roughly half of that enrollment.

Virginia is a tort state for auto injuries, so standard coordination of benefits applies rather than an auto carrier taking first position. The injury still has to be identified at registration, because liability coverage may be primary for the related care.

Virginia attaches criminal penalties to percentage-based fee-splitting arrangements. Our pricing in Virginia is set accordingly, and it is confirmed in writing before any work begins. That describes what we charge; your own position is a question for your counsel rather than for us.

No — we work remotely with practices in all 50 states and DC. What matters is that somebody is tracking Virginia's rules against your actual claims: its Medicare contractor, its Medicaid structure, and its auto-injury sequencing.

bill the plan that actually adjudicates rather than the program on the card, track filing windows per plan, which are frequently shorter than commercial, verify eligibility every visit, because Medicaid coverage churns monthly, and the follow-up that goes with them. Medicaid claims go to the right payer, in the right order, inside the right window.