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Virginia Medicaid enrollment

Every clinician who sees Virginia Medicaid members, in fee-for-service or a Cardinal Care health plan, enrolls with DMAS first and then joins each plan. Here is how the two steps work and how they connect.

Checked against DMAS, the Cardinal Care contract and each plan's page on October 12, 2026. Confirm current steps with DMAS and each plan before you file.

1. Enroll with DMAS in PRSS

DMAS says: "Medicaid fee-for-service and Managed Care Organization (MCO) network providers need to enroll in PRSS and revalidate enrollment at least every five years." PRSS, the Provider Services Solution, is the provider portal of the Medicaid Enterprise System.

Where to apply. Online through the PRSS enrollment page (virginia.hppcloud.com). Paper applications are no longer accepted.
Every NPI and every location. Providers with more than one NPI must enroll all of them, and practices with more than one service location must enroll every location.
Ordering, referring and prescribing. DMAS's managed care page says the requirement "includes billing, servicing, ordering, referring, or prescribing (ORP) providers" serving members through the plans or fee-for-service.
Effective date. "The 1st day of the month in which the application is received," unless DMAS approves a retroactive date for documented extenuating circumstances. Filing early in the month matters.
Processing. DMAS says an enrollment request "can take up to 10 business days to process," and that a fee, site visit or background check can extend it.
Deadlines inside PRSS. An application that is not submitted and sits inactive for 30 days expires. If DMAS returns it for corrections, you have 30 days to fix and resubmit it, or it is denied.
Application fee. Institutional providers may owe a federally required fee that CMS sets each year; it is not owed to DMAS if already paid to Medicare or another state. Federal rules exempt individual physicians and non-physician practitioners. PRSS shows "No Fee" or the amount due.
Dentists enroll with DentaQuest, the DMAS dental benefits administrator, not in PRSS.
Help. The Virginia Medicaid Provider Enrollment Helpdesk is 804-270-5105 or 888-829-5373.

Sources (checked Oct 12, 2026)

2. Join each Cardinal Care plan

"All managed care and fee-for-service Medicaid members are part of the Cardinal Care program." DMAS says providers "must enroll with the State via PRSS and Contract with the Managed Care Plans individually." DMAS cannot change a provider's plan participation; each plan manages its own network.

The Cardinal Care contract sets rules each plan must follow:

PRSS first. Before finalizing a provider contract, the plan must make sure the provider is screened, enrolled and periodically revalidated in PRSS.
A 120-day window. A plan may sign a provider agreement of up to 120 days while PRSS enrollment is pending, but must end it if enrollment does not happen in that period.
No payment without enrollment. Plans must not pay claims to network providers who are not enrolled in PRSS.
Credentialing deadlines. Plans must approve or deny a completed credentialing application within 60 days, and pay pending-period claims no later than 40 days after the provider is credentialed and contracted (the same rules as Va. Code § 38.2-3407.10:1).
CAQH accepted. Plans must let providers use the CAQH standardized credentialing form.
Denials in writing. If a plan denies an application, it must give the reason in writing.

Plan	How it starts	Timing reported
Aetna Better Health of Virginia	Its Virginia join page, linked from DMAS's managed care page.	DMAS (Aug 2025): "anywhere from 30 to 120 days depending on the case," typically 30 to 45 business days.
Anthem HealthKeepers Plus	Complete DMAS enrollment in PRSS first, then apply. Uses CAQH ProView.	Anthem: "typically takes 45 days" from receipt of your completed CAQH application. Recredentials every three years.
Humana Healthy Horizons in Virginia	Requires enrollment through the DMAS PRSS enrollment wizard.	Humana: notice within 30 days if anything is missing, and a decision within 60 days once complete.
Sentara Community Plan (listed by DMAS as Sentara Health Plans)	A Request for Participation form on Sentara's join page.	DMAS (Aug 2025): "typically takes under 90 days." Behavioral health: see below.
UnitedHealthcare Community Plan	UnitedHealthcare's provider channels for Virginia Medicaid.	DMAS (Aug 2025): "typically takes 45 to 90 days."

Sentara behavioral health. Sentara says its plan "is full and sufficient for Behavioral Health providers in all of our service locations for all provider types and specialties," and that new requests are added to a behavioral health waiting list.

DMAS's timing figures come from its August 2025 implementation FAQ. Ask each plan for its current estimate.

Sources (checked Oct 12, 2026)

3. Revalidation

At least every five years. Federal rules require the state to revalidate every provider's enrollment at least every 5 years.
Notices. DMAS says providers should receive a notice at least 90 days before the enrollment period ends, with reminders at 60 and 30 days.
Grace period. Up to 45 days for a revalidation that has not been submitted; none if the revalidation was returned to the provider.
Missing it. Providers who do not revalidate on time "will have their Virginia Medicaid participation status terminated from fee-for-service and MCO networks" until they enroll or revalidate in PRSS.

Sources (checked Oct 12, 2026)

4. Why this is federal, not just Virginia

Federal rules require every state to "screen and enroll, and periodically revalidate, all network providers" of its Medicaid managed care plans. The same rule adds that this "does not require the network provider to render services to FFS beneficiaries." Commercial plans and Medicare are covered on our Virginia payer enrollment guide.

Sources (checked Oct 12, 2026)

42 CFR 438.602

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This page is general information, not legal advice. Rules and payer processes change; always follow the payer's or agency's current instructions. Payer, agency and product names belong to their owners and are used only to describe what each step involves.