Medical Billing Services in Virginia
Virginia’s Medicaid program recently went through a consolidation that changed how every claim in the state should be handled. Two older programs were unified under one brand, Cardinal Care, but coverage itself still runs through five separate managed care organizations, each with its own claim rules, clearinghouse payer IDs, and prior authorization requirements. A practice that treats Cardinal Care as a single payer will bill correctly in name and deny in practice.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for Virginia practices of every specialty, built around the state’s actual payers and programs.
Virginia’s payer landscape
Virginia Medicaid is called Cardinal Care, administered by the Department of Medical Assistance Services (DMAS). Since July 1, 2025, it is delivered through five managed care organizations: Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons, Sentara Health Plans, and UnitedHealthcare Community Plan. Humana Healthy Horizons replaced Molina in that July 2025 procurement, so older plan lists should not be relied on.
Enrollment has two parts, and missing the second is a common denial source. Providers enroll with the state first through the DMAS Provider Services Solution portal, then contract separately with each Cardinal Care MCO they want to bill. State enrollment alone does not place a practice in every MCO network, and an MCO-enrolled patient treated before network participation is secured denies as non-participating.
Commercial coverage is led by Anthem, alongside Sentara, Aetna, Cigna, UnitedHealthcare, and Kaiser Permanente. Medicare Part B claims run through Palmetto GBA, Jurisdiction JM, and Medicare Advantage plans add their own prior authorization rules on top of the Cardinal Care and commercial mix.
What MedPlus RCM handles for Virginia practices
- End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
- Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
- Provider credentialing and enrollment. End-to-end enrollment with Cardinal Care MCOs, commercial payers, and Medicare, plus re-credentialing maintenance.
- Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
- A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
- Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
We serve practices statewide, Virginia Beach, Norfolk, Richmond, Arlington, Alexandria, and Chesapeake, across specialties including primary care, mental and behavioral health, cardiology, orthopedics, dermatology, and physical therapy.
Results Virginia practices can check
MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.
Frequently asked questions
Is Cardinal Care a single payer?
No. Cardinal Care is the program brand, but coverage runs through five separate MCOs, each with its own claim submission rules, payer IDs, and authorization requirements.
Do you work with Cardinal Care MCOs?
Yes. We bill Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons, Sentara Health Plans, and UnitedHealthcare Community Plan, as well as commercial and Medicare plans.
Does DMAS enrollment cover all Cardinal Care plans?
No. State enrollment through the DMAS portal is only the first step. A practice must contract separately with each MCO it wants to bill.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.
Get a free financial audit
Find out where your Virginia practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
