Please follow the Enrollment Instructions below to become an electronic submitter for Virginia Medicaid.

In order to begin filing claims electronically you must first be actively enrolled with Virginia Medicaid.

Required Documents for those applying for new Submitter ID's.

The following documents are required enrollment documents that must be completed, signed and returned to the Virginia Medicaid office prior to initiation of electronic claims submission or inquiry

Please complete the following forms:

1. Electronic Claims Submission Enrollment Packet

If the above link does not work properly, please download the packet from:
www.virginiamedicaid.dmas.virginia.gov

If you have any questions regarding any of the documents in this package, please call EDI Technology Support Center at 1-866-352-0766 Monday-Friday 8:00 a.m. - 5:00 p.m.

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

EDI Form 101 - Submission of Electronic Transactions Agreement for Service Centers

Section 1: Submitter Information

• Enter your Business/Practice or Provider Name

• Address

• Today's Date

• Complete #6 with your information on the right side of the box

• Please leave the Service Center Number line blank

EDI Form 102 - Service Center Operational Information

Section 1:

• Please specify if you are an Individual or Group practice

Section 1a:

• Please indicate how you will be submitting: Choose Software Vendor if you are using Claimshuttle and your own software. If you have purchased our billing software please call us for that information

  • If you are using a Billing Service please select Billing Agent

Section 2:

• Please enter your Business/Practice or Provider name

• Address

• Name of the main Contact person for your office

• Phone and Fax numbers

• Office e-mail address

• Specialty

Section 3:

• Please enter the information for the software or vendor that creates your 837 files you need Claimshuttle to transfer for you.

• If you have paid for our billing software please call our support line for our software information.

If you are using a Billing Service, enter your Billing Services 4 digit submitter ID in the Service Center Number box. Section 4: Electronic Transaction Types Please mark to "Add" the following:

• Remittance Advice (835)- To receive your EOB's electronically in Claimshuttle

• Professional(837P)- For CMS 1500 claims

• Institutional(837I)- For UB04 claims

Provider Service Center Authorization (Billing Agency or Clearinghouse Authorization)

Providers Using Claimshuttle can skip this form
NOTE to Billing Services: Each provider that you are billing for must complete this form

Section 1:

• Check the box to certify you're authorizing a Billing Agency to receive your 835's

• Enter the Service Center Number (Submitter ID) of the Billing Agency or Clearinghouse

Section 1a:

• Select the time frame you wish to continue receiving your paper remittances

• If no time frame is selected, the default is 60 days

Section 1b:

• Only fill in this section if you are currently attached to a different Service Center to accept and process your electronic remittances

• If so, check the box, enter the Service Center Number to be terminated, and enter today's date

Please skip Section 2 and 2a

Section 3: Signature

• Complete the bottom of the form and sign

Submitting your Forms

Please return the Electronic Claims Submission enrollment packet via fax at 1-888-335-8460 or email to
Virginia.edisupport@conduent.com

It is recommended that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing can take up to two weeks from the date of receipt.

After processing, a confirmation will be emailed to you as notification to begin filing claims electronically. If confirmation is not received after two weeks, contact the Virginia Medicaid EDI Technology Support Center at (800)924-6741.

Testing

Once you have received your Submitter ID and Password from Medicaid, please call the Claimshuttle Support Team and set an appointment for a Mailbox setup and Test Transmission.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment, but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.