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Virginia Medicaid
Virginia Medicaid, a matching record and paid
An active Virginia Medicaid ID, a record that matches what you bill, and revalidation done before the due date.
Virginia Medicaid enrollment pays off when the enrollment record stays current and matches what you bill, because DMAS and the managed care plans are prohibited from paying claims to network providers who are not enrolled in the correct provider type and specialty. Start on the DMAS Provider Enrollment and Revalidation page.
Revalidation cycle
Medicaid fee for service and managed care network providers need to revalidate enrollment at least every five years, and DMAS notice should arrive at least 90 days before the enrollment period ends. DMAS, Provider Enrollment and Revalidation
Missed deadline
Providers who do not revalidate by the due date have their Virginia Medicaid participation terminated from fee for service and managed care networks. DMAS, Provider Enrollment and Revalidation
License lapse
DMAS ended its 90 day grace period after license expiration beginning July 1, 2025. DMAS, Updated Provider Enrollment Requirements
Who can be paid
DMAS and the managed care plans are prohibited from paying claims to network providers who are not enrolled in the correct provider type and specialty for the services billed. DMAS, Updated Provider Enrollment Requirements
What we see in practice
45 to 90 days from submission to an active Medicaid ID.
In the official words
Providers who do not revalidate by the revalidation due date will have their Virginia Medicaid participation status terminated from fee-for-service and MCO networks
Providers should receive a DMAS notice to begin their revalidation applications at least 90 days before the end of their enrollment period.
The 90 day license grace period ended July 1, 2025
Historically, DMAS allowed a 90 day grace period following license expiration. Beginning July 1, 2025, that grace period no longer applies. All new or returning providers are now enrolled based on the month they apply or request reinstatement after any lapse in enrollment. DMAS
DMAS sends courtesy notices 90, 60 and 30 days before license expiration to help support continuous enrollment. DMAS
How enrollment works, step by step
- Start on the DMAS Provider Enrollment and Revalidation page, which points to the Provider Enrollment home page for new enrollments and revalidations. DMAS
- Make sure enrollment is current and active for every service location and provider type. DMAS
- Match what you bill to what you enrolled. The services provided and billed must align with the enrolled provider type and specialty, and services must be billed as rendered, under the rendering provider's NPI. DMAS
- Check periodically that enrollment, contact information and license information are up to date for every service location. DMAS
- For help with an enrollment or revalidation question, DMAS lists Gainwell as the contact. DMAS
In Virginia the dates come from the license and the record. Since July 1, 2025 a provider returning after a lapse is enrolled from the month it applies or requests reinstatement, so every week the file waits is a week without coverage. The enrolled provider type and specialty also have to match what you bill, and a correction there adds a round of review. Counting those rounds, we put a Virginia file at 45 to 90 days from submission to an active Medicaid ID.
Risk screening and the five year revalidation
DMAS screens all providers under federally mandated requirements before approving or renewing participation. It also performs monthly screening of all participating providers, plus a further screening at the time of revalidation. DMAS
Providers in the fee for service and managed care networks must revalidate at least every five years. DMAS says to expect a notice at least 90 days before the enrollment period ends, sent by email or U.S. Mail, and to begin the application on receipt to allow sufficient time for processing. A revalidation application has to be submitted before the end of the enrollment period, without a gap. DMAS
Where Virginia enrollments lose money
The costliest loss is a missed revalidation. Providers who do not revalidate by the due date have their Virginia Medicaid participation terminated from fee for service and managed care networks until they successfully enroll or revalidate. DMAS
The second is a mismatch between the enrollment record and the claim. DMAS and the managed care plans are prohibited from paying claims to network providers who are not enrolled in the correct provider type and specialty for the services billed. DMAS
Check where you stand before you submit
WeBill Health runs Revenue Velocity Credentialing with 24/7 CAQH and PECOS lifecycle monitoring, so revalidation dates and affiliation gaps are caught before they become suspended claims. Every file gets Human Expert Review from a credentialing specialist before it goes to the state.
Revenue Velocity Credentialing
WeBill Health manages the full payer enrollment lifecycle, so your revenue cycle starts the moment your practice does.
Up to 40%
less payer enrollment lag against the industry baseline
24/7
CAQH and PECOS lifecycle monitoring
Review your enrollment status with us
The Revenue Defense Audit is a free, forensic review of your claims and A/R by the team that would work your account, including providers seeing patients under a payer that cannot pay them yet.
Want a quick read first? Check my Revenue Defense Score for the credentialing and denial exposure in your specialty.
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