Jogaza Credentialing

Virginia Medicaid credentialing for nurse practitioners

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Short answer

  • Two steps: enroll with DMAS (Virginia Medicaid) first, then join each Cardinal Care managed care plan separately.
  • A participation request in the DMAS PRSS portal is not a contract. Two months after enrollment, every plan still showed our practice as non-participating.
  • Most Medicaid members are in a managed care plan, so DMAS approval alone rarely gets you paid.

Step 1: enroll with DMAS

Enroll through the Virginia Medicaid Enterprise System provider portal. Enroll the group (your LLC's Type 2 NPI and EIN) and yourself (Type 1 NPI), linked to the group. DMAS sends a welcome letter for each with the effective date and a Provider Location ID for the group.

Keep two numbers straight: the 10-digit Medicaid provider ID and the 14-digit service location ID. Plan forms ask for different ones. Humana's form, for example, accepts only 6 to 13 characters, so it wants the 10-digit ID.

Step 2: join each Cardinal Care plan

Virginia's Medicaid program, Cardinal Care, is run by managed care plans. Each one credentials and contracts you itself, and behavioral health is often handled by a separate company:

  • Aetna Better Health of Virginia: email a letter of interest and W-9 to its Network Development team. Contracting replies with a credentialing application and a Disclosure of Ownership form, then sends the contract by Adobe Sign.
  • Anthem HealthKeepers Plus: behavioral health is credentialed by Carelon Behavioral Health. See the Carelon guide.
  • Humana Healthy Horizons in Virginia: Humana's online Request to Join form, not Availity. See the Humana guide.
  • Sentara Community Plan: a Request for Participation emailed to Sentara. The behavioral health network was full in 2026. See the Sentara guide.
  • UnitedHealthcare Community Plan of Virginia: behavioral health is Optum, joined through Provider Express. See the Optum guide.

The PRSS portal and delegates

DMAS's PRSS portal has an MCO Network tab where participation requests are recorded. In our case, requests made at enrollment (effective August 1) still showed Participation Status "No" for every plan two months later. Use the tab to check status, and contact each plan directly to actually join.

If someone else handles your credentialing, the practice owner can add them as a delegate in PRSS. They get their own login, so you never share yours. The delegate and the service location association both need to show Active.

What Aetna Better Health asked for

  • A 19-page packet: practitioner application, Medicaid supplement, Disclosure of Ownership, employment and cultural competency attestations, and a staffing attestation for mental health services.
  • CPT codes you bill, service area, whether you offer telehealth, and the owner's contact details.
  • A W-9 that matches the IRS letter exactly, a certificate of insurance, and the license as a PDF.
  • After a complete packet, contracting forwarded it to credentialing: 60 to 120 business days.

Check every page before sending. One blank attestation page sent the whole packet back.

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