Heavy workers compensation and auto exposure, both of which are governed by state schedules rather than your commercial contracts. In Virginia that plays out against a specific set of rules rather than a general one.
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
Coding driver
Timed treatment codes, where unit calculation is systematic rather than occasional — an error repeats on every visit.
Medicare contractor
Palmetto GBA (JM)
Medicaid program
Cardinal Care
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.
Where physical therapy claims fail
- Unit counts that do not match documented treatment time
- Visit caps reached without notice
- Provider did not re-certify the plan of care in time
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 physical therapy denials.
Scope
A written scope and price before any work starts.
Transition
Coding and submission move across without a gap.
Report
Denial causes segmented by payer and provider.
Physical Therapy Billing in Virginia — Frequently Asked Questions
Do physical therapy billing rules differ in Virginia?
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Cardinal Care is delivered through commercial managed care plans, each setting its own filing window and authorization rules.
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