Medical Billing Services in Virginia
As a remote-first medical billing company serving Virginia practices statewide, MedPrecision pairs VA-specific payer expertise with AAPC-certified billing experts. Virginia Medicaid no longer runs Medallion 4.0: on 1 October 2023 the Department of Medical Assistance Services combined Medallion 4.0 and CCC Plus into Cardinal Care Managed Care, and since 1 July 2025 members choose among five health plans — Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons, Sentara Health Plans and UnitedHealthcare Community Plan — with Molina's members moved to Humana. Claims must reach Medicaid within 12 months of the date of service, and a denied claim has to be resubmitted and processed on or before 13 months from that first denial. On the commercial side, Virginia Code 38.2-3407.15 requires a carrier to pay any claim within 40 days of receipt and to notify you of a defect within 30 days, so prompt-pay tracking is part of every weekly A/R review we run for Virginia accounts. We run Virginia claim queues with payer-segmented edits, portal automation for the Cardinal Care plans and Anthem Blue Cross Blue Shield, and appeal letters drafted against the rule that actually governs that payer.
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The Virginia Billing Landscape
Virginia expanded Medicaid on 1 January 2019, covering adults up to 138 percent of the federal poverty level, and the program has been reorganised twice since. On 1 October 2023 the Department of Medical Assistance Services merged Medallion 4.0 and Commonwealth Coordinated Care Plus into one program, Cardinal Care Managed Care, so members no longer switch programs as their needs change; on 1 July 2025 the plan line-up settled at five — Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons of Virginia, Sentara Health Plans and UnitedHealthcare Community Plan — with Molina out of the program and its members moved to Humana. Any Virginia billing workflow still keyed to Medallion 4.0, Optima or Molina IDs is generating avoidable denials. The commercial market is led by Anthem Blue Cross Blue Shield, CareFirst in Northern Virginia, UnitedHealthcare, Cigna and Sentara Health Plans. Northern Virginia's proximity to Washington DC creates a market where federal employee health plans are a significant payer source — and those plans, like TRICARE and Medicaid, sit outside Virginia's prompt-pay statute, which reaches state-regulated commercial coverage only. That statute, Code 38.2-3407.15, gives a carrier 40 days from receipt to pay a claim and 30 days to notify the submitter of a defect; miss the notice and the claim is deemed clean. Virginia also has its own balance-billing law, Code 38.2-3445.01, covering emergency services and out-of-network surgical or ancillary services at in-network facilities, with arbitration when the carrier and provider cannot agree. Sentara Health, Inova Health System, VCU Health, and Carilion Clinic are the major health systems, each with regional dominance. The Hampton Roads, Richmond, and Northern Virginia markets are competitive with high provider density, while rural Virginia — particularly Southside and Southwest — faces provider shortages and hospital closures. The state's military population near Norfolk, Quantico, and the Pentagon creates substantial TRICARE billing volume. Virginia's diverse geography and demographics mean practices face vastly different payer mixes depending on their location.
Who We Serve in Virginia
Our Virginia client mix skews toward solo practices, group practices, laboratory services , plus multi-specialty clinics and telehealth providers. We work with providers in Virginia Beach, Norfolk, Chesapeake and across the rest of the state, all remotely.
Major Metros Served
What billing costs in Virginia
We publish one national rate card and bill Virginia practices on exactly the same terms as everywhere else — there is no regional markup and no quote-only tier below enterprise. You pay a percentage of what we actually collect, so if we do not collect, you do not pay.
| Practice size | Rate | Basis | Note |
|---|---|---|---|
| Solo practice | 7.0% | of monthly collections | Monthly minimum applies |
| Group practice | 6.0% | of monthly collections | Volume discounts available |
| Enterprise | Custom | tiered pricing | Scoped per engagement |
- No setup or implementation fee
- No per-claim charge
- No software fee and no markup on third-party costs — clearinghouse fees, postage and payer application fees are passed through at cost
- 12-month initial term, then month-to-month — 60 days' notice either way, no early-termination penalty
Payer Landscape in Virginia
Cardinal Care Managed Care (Virginia Medicaid; replaced Medallion 4.0 and CCC Plus on 1 October 2023) routes members through Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons of Virginia and 2 more plans, each with its own authorization rules and fee schedule. On the commercial side, Anthem Blue Cross Blue Shield, UnitedHealthcare, Aetna drive the bulk of Virginia claim volume, so we maintain payer-specific denial playbooks and appeal templates for each. Claim clocks in Virginia run 365 days for Medicaid and 90-180 days for commercial payers — deadlines our A/R queues are built around. Virginia's prompt-pay statute: Virginia Code 38.2-3407.15 requires every provider contract entered into by a carrier to contain minimum fair business standards: the carrier pays any claim within 40 days of receipt, except where its obligation is not reasonably clear for a reason the statute lists, and notifies the person submitting the claim within 30 days of any defect or impropriety that prevents it being treated as clean — failing which the claim is deemed clean. Interest comes from Code 38.2-3407.1, computed daily at the legal rate from 15 working days after receipt of proof of loss, and must be paid without demand when the claim is paid or within 60 days after. The section's definition of a health plan excludes Medicare, Medicaid, CHIP, federal employee coverage and TRICARE. Verified against the Code of Virginia on 17 September 2026.
Medicaid Program
Cardinal Care Managed Care (Virginia Medicaid; replaced Medallion 4.0 and CCC Plus on 1 October 2023)
Managed Care Organizations
Key Commercial Payers
Timely Filing Deadlines
Prompt Pay Law
Virginia Code 38.2-3407.15 requires every provider contract entered into by a carrier to contain minimum fair business standards: the carrier pays any claim within 40 days of receipt, except where its obligation is not reasonably clear for a reason the statute lists, and notifies the person submitting the claim within 30 days of any defect or impropriety that prevents it being treated as clean — failing which the claim is deemed clean. Interest comes from Code 38.2-3407.1, computed daily at the legal rate from 15 working days after receipt of proof of loss, and must be paid without demand when the claim is paid or within 60 days after. The section's definition of a health plan excludes Medicare, Medicaid, CHIP, federal employee coverage and TRICARE. Verified against the Code of Virginia on 17 September 2026.
Virginia Billing Regulations & Compliance
The Virginia State Corporation Commission, Bureau of Insurance sets the rules our Virginia billing workflows have to satisfy. Surprise billing in Virginia: Virginia Code 38.2-3445.01 prohibits an out-of-network provider from balance billing an enrollee for emergency services, or for non-emergency surgical or ancillary services delivered by an out-of-network provider at an in-network facility; the enrollee owes only in-network cost sharing. The carrier must offer the provider a commercially reasonable amount within 30 calendar days of a clean claim, the provider has 30 calendar days from payment or notification to dispute it, there is a 30-day good-faith negotiation period, and unresolved disputes go to arbitration under Code 38.2-3445.02. The federal No Surprises Act applies alongside it. Verified against the Code of Virginia on 17 September 2026. Telehealth parity: Virginia Code 38.2-3418.16 requires insurers, health services plan corporations and HMOs to cover health care services delivered through telemedicine, bars excluding a service from coverage solely because it was delivered that way, and requires reimbursement on the same basis as the same service delivered face to face, with cost sharing no higher than the in-person equivalent. Two limits matter operationally: the section's definition of telemedicine services excludes audio-only telephone, email, fax and online questionnaires — while expressly not precluding coverage of real-time audio-only care — and the requirements do not apply to Medicare-eligible coverage or similar federal plans. Medicaid telehealth coverage is set by the Department of Medical Assistance Services rather than by this section. Verified against the Code of Virginia on 17 September 2026.
State Insurance Regulator
Virginia State Corporation Commission, Bureau of Insurance
Surprise Billing Protection
Virginia Code 38.2-3445.01 prohibits an out-of-network provider from balance billing an enrollee for emergency services, or for non-emergency surgical or ancillary services delivered by an out-of-network provider at an in-network facility; the enrollee owes only in-network cost sharing. The carrier must offer the provider a commercially reasonable amount within 30 calendar days of a clean claim, the provider has 30 calendar days from payment or notification to dispute it, there is a 30-day good-faith negotiation period, and unresolved disputes go to arbitration under Code 38.2-3445.02. The federal No Surprises Act applies alongside it. Verified against the Code of Virginia on 17 September 2026.
Telehealth Billing Parity
Virginia Code 38.2-3418.16 requires insurers, health services plan corporations and HMOs to cover health care services delivered through telemedicine, bars excluding a service from coverage solely because it was delivered that way, and requires reimbursement on the same basis as the same service delivered face to face, with cost sharing no higher than the in-person equivalent. Two limits matter operationally: the section's definition of telemedicine services excludes audio-only telephone, email, fax and online questionnaires — while expressly not precluding coverage of real-time audio-only care — and the requirements do not apply to Medicare-eligible coverage or similar federal plans. Medicaid telehealth coverage is set by the Department of Medical Assistance Services rather than by this section. Verified against the Code of Virginia on 17 September 2026.
Common Questions
Common questions about medical billing services in Virginia.
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Get a Free Billing AuditHow does MedPrecision handle Cardinal Care Medicaid managed care billing?
Virginia combined Medallion 4.0 and Commonwealth Coordinated Care Plus into a single program, Cardinal Care Managed Care, on 1 October 2023, and the plan line-up changed again on 1 July 2025. The Department of Medical Assistance Services now lists five plans: Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons of Virginia, Sentara Health Plans and UnitedHealthcare Community Plan. Molina left the program and its members were moved to Humana effective 1 July 2025, which is a live source of denials for practices still holding Molina IDs on file. We verify the member's current plan before submission, work each plan's authorization rules and claim address, and keep claims inside the 12-month Medicaid filing limit (verified at dmas.virginia.gov on 17 September 2026).
Can MedPrecision manage the payer complexity of Northern Virginia's DC corridor?
Yes, and the Northern Virginia mix is where a Virginia-specific trap sits. Virginia's prompt-pay statute, Code 38.2-3407.15, defines the health plans it covers so as to exclude Medicare, Medicaid, CHIP, federal employee coverage under 5 U.S.C. 8901 and TRICARE under 10 U.S.C. 1071. So the 40-day payment standard practices rely on does not apply to a FEHB or TRICARE claim, and chasing one with a prompt-pay argument wastes a cycle. Our billers work each of those books on its own rules — federal employee plans, TRICARE, multi-state Medicaid and commercial carriers across the DC metro — and reserve the state prompt-pay lever for the claims it actually reaches.
How do Virginia prompt pay laws affect my reimbursements?
Virginia Code 38.2-3407.15 requires every provider contract to hold the carrier to minimum fair business standards: pay any claim within 40 days of receipt unless the obligation is not reasonably clear for a listed reason, and notify the person who submitted the claim within 30 days of any defect or impropriety that stops it being a clean claim. The 30-day figure is the notice deadline, not a payment deadline — a distinction that decides whether a follow-up call has anything behind it. If the carrier does not send that notice in time, the claim counts as clean. We track claim aging against both deadlines and take prompt-pay complaints to the State Corporation Commission's Bureau of Insurance when a carrier will not pay.
Does MedPrecision support laboratory billing for Virginia practices?
Yes. Virginia has a strong laboratory and diagnostic services market, and we provide specialized lab billing support including proper use of CPT and HCPCS codes, compliance with payer-specific panel unbundling rules, and management of medical necessity documentation to reduce denials and increase lab reimbursements.
What happens if a payer misses the Virginia prompt-pay deadline?
Virginia Code 38.2-3407.15(B)(1) gives a carrier 40 days from receipt to pay a claim, with the exceptions the statute lists, and (B)(2) gives it 30 days to notify you of any defect that prevents the claim from being clean. Interest is not set by that section: under Code 38.2-3407.1 interest is computed daily at the legal rate from 15 working days after the insurer receives proof of loss until the claim is paid, and 38.2-3407.15 requires any interest owed to be paid without demand, at the time the claim is paid or within 60 days after. The statute reaches state-regulated commercial coverage only — Medicare, Medicaid, CHIP, FEHB and TRICARE are excluded from its definition of a health plan. We track every claim against these deadlines, flag stalled payments in our A/R reports, and escalate to the Virginia State Corporation Commission, Bureau of Insurance when a carrier defaults. Filing deadlines are separate: Virginia Medicaid requires initial claims within 12 months of the date of service and resubmission of a denied claim on or before 13 months from the initial denial, while commercial claims typically run 90-180 days. Verified against the Code of Virginia and the DMAS Practitioner Provider Manual on 17 September 2026.
How do I choose a medical billing company in Virginia?
Prioritize a billing company that already works with Cardinal Care Managed Care and the major commercial payers in Virginia — payer-specific edits and timely-filing windows are where most VA revenue leaks start, and a billing team still calling the program Medallion 4.0 has not been reading Virginia Medicaid's notices. Ask about AAPC-certified coders, transparent pricing, and denial-rate and days-in-A/R reporting before you sign. Because billing is delivered remotely, a company's Virginia payer experience matters more than a local office address.
Services for Virginia practices
Specialties we bill for
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Services in Virginia
Specialties in Virginia
Other Locations We Serve
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