Workers compensation runs on a state fee schedule, state forms, and state timelines. A process that works in one state is frequently invalid one state line away, which is why it is so often the worst-performing segment of a practice’s A/R.
Claims for Virginia providers are adjudicated by Palmetto GBA (JM), which is also who hears the first level of appeal — so an appeal argument that works here works in every state that contractor covers.
At a glance
Medicare contractor
Palmetto GBA (JM)
Medicaid program
Cardinal Care
Managed care
Predominantly commercial plans
Auto injuries
Tort state — health plan sequencing applies
What changes in Virginia
Medicaid in Virginia runs as Cardinal Care and is delivered largely through commercial managed care plans, so most Medicaid claims are adjudicated by an insurer with its own filing window and its own authorization rules rather than by the state.
Virginia attaches criminal penalties to percentage-based fee-splitting arrangements. Our own pricing in Virginia is set accordingly. That describes what we charge; your own position is a question for your counsel rather than for us.
What we do
- Bill against the applicable state fee schedule rather than your commercial rates
- Track authorization and reporting requirements specific to the jurisdiction
- Manage the documentation these carriers require and commercial payers do not
- Follow up on the longer payment cycles these claims run on
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at your Virginia aging and denial mix.
Scope
A written scope and price before any work starts.
Transition
No gap in submission during the handover.
Report
Six numbers monthly, segmented by payer.
Workers Compensation Billing in Virginia — Frequently Asked Questions
Which Medicare contractor covers Virginia?
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Palmetto GBA (JM). That is who adjudicates your Medicare claims and who hears a redetermination.
Is Virginia Medicaid managed care?
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Cardinal Care is delivered largely through commercial managed care plans, so the plan sets the filing window and the authorization rules, not the state.
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