Virginia Medical Billing: Medicare, Medicaid, and Auto Injury Claims
Jump to a section
Full transcript
Overview
Virginia practices need a billing workflow that keeps Medicare, Medicaid, auto injury claims, and appeal routing clearly organized.
Medicare contractor
Medicare claims are administered by Palmetto GBAJM, and that same contractor hears the first level of Medicare appeal.
Medicaid program
Medicaid runs as Cardinal Care and is delivered largely through commercial managed care plans. So most Medicaid claims go to an insurer with its own filing window and authorization rules rather than directly to the state.
Auto injuries
Virginia is a tort state for auto injuries, so standard coordination of benefits applies instead of a no-fault carrier taking first position.
Coverage and pricing
Local coverage determinations can also affect whether the same service is covered in Virginia but handled differently in another state.
Coding, claims, and follow-up
WGMB supports Virginia practices with certified coding, charge entry, claim scrubbing, electronic submission, clearinghouse rejection follow-up, denial management, payment posting, accounts receivable follow-up, coordination of benefits, patient statements, payment plans, and billing support.
The takeaway
For Virginia practices, the goal is to keep payer order clear, claims moving, and billing follow-up easier to manage.
What is different about billing in Virginia?
- Medicare contractor
- Palmetto GBA (JM)
- Medicaid program
- Cardinal Care
- Medicaid delivery
- Commercial managed care plans
- Auto injuries
- Tort: standard coordination of benefits
Want your Virginia claims worked for you?
We code, submit, and follow up on claims for Virginia practices, with Medicare appeals worked to Palmetto (JM) and Medicaid billed to Cardinal Care. Tell us about your practice and we'll send a written scope and price.
More state videos
Also for Virginia practices
White Glove Medical Billing is a medical billing, coding, and revenue cycle company — not a healthcare provider and not a law firm. All coding is performed by certified coders from your providers' documentation; the clinical record and the certification of medical necessity remain the provider's.