How to become a Medicaid provider in Virginia
To bill Virginia Medicaid, enroll through Medicaid Enterprise System (MES) Provider Services Solution (PRSS), the 'Provider Portal', run by Gainwell Technologies. The process has 5 steps, listed below with the documents the state asks for.
- Enrollment portal
- Medicaid Enterprise System (MES) Provider Services Solution (PRSS), the 'Provider Portal'
- Steps
- 5
- Documents
- 3
- Plans listed
- 5
On this page
Virginia Medicaid enrollment at a glance
To bill Virginia Medicaid, enroll through Medicaid Enterprise System (MES) Provider Services Solution (PRSS), the 'Provider Portal', run by Gainwell Technologies. The process has 5 steps, listed below with the documents the state asks for.
- Program
- Virginia Medicaid / Cardinal Care (Department of Medical Assistance Services, DMAS)
- Enrollment portal
- Medicaid Enterprise System (MES) Provider Services Solution (PRSS), the 'Provider Portal'
- Fiscal agent
- Gainwell Technologies (PRSS enrollment and revalidation support and notices)
- Application fee
- Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. DMAS's revalidation plan says every revalidation includes collecting the application fee. The enrollment page does not list a separate state fee.
- Fingerprinting
- DMAS designates nursing facilities, DME, hospice, home health, prosthetic devices and doula services as high categorical risk. Its revalidation plan includes background checks for these providers. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.
- Site visit
- DMAS's revalidation plan includes site visits for applicable provider types, including high-risk providers and the moderate-risk providers being revalidated off-cycle. Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections.
- Revalidation
- Fee-for-service and MCO network providers enroll in PRSS and revalidate at least every five years. DMAS sends a notice at least 90 days before the enrollment period ends, with Gainwell reminder emails at 60 and 30 days. Revalidation is electronic only, through PRSS (see the Manage Revalidation panel). Missing it ends participation in both fee-for-service and MCO networks. Under DMAS's June 2026 CMS strategy, high-risk types (nursing facilities, DME, hospice, home health, prosthetic devices, doula services) move to a 3-year cycle on July 1, 2027. The 808 high-risk providers will be revalidated off-cycle from August to December 2027, and some moderate-risk providers in early 2028.
- Provider manual
- Provider manual
Steps
- Get an NPI
- Start a new enrollment from the PRSS Provider Enrollment home page in the MES portal
- Fill out the application and upload the required documents; pay the application fee if applicable
- Complete screening (site visit and background checks for applicable risk levels)
- Contract and credential with each Cardinal Care MCO using the MCO Provider Network Resources contacts; MCO participation status shows in PRSS
Documents the state asks for
Joining managed-care plan networks
- Credentialing
- Even when serving only managed care members, providers must enroll and periodically revalidate directly with DMAS in PRSS. They then contract and credential with each Cardinal Care MCO, which DMAS links from its MCO Provider Network Resources page. DMAS describes no centralized credentialing.
- Plans (state list)
- Aetna Better Health of Virginia
- Anthem HealthKeepers Plus
- Humana Healthy Horizons of Virginia
- Sentara Health Plans
- United Healthcare of the Mid-Atlantic, Inc. (UnitedHealthcare Community Plan)
Frequently asked questions
How do I become a Medicaid provider in Virginia?
To bill Virginia Medicaid, enroll through Medicaid Enterprise System (MES) Provider Services Solution (PRSS), the 'Provider Portal', run by Gainwell Technologies. The process has 5 steps, listed below with the documents the state asks for.
Is there an application fee to enroll in Virginia Medicaid?
Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. DMAS's revalidation plan says every revalidation includes collecting the application fee. The enrollment page does not list a separate state fee.
How often must Virginia Medicaid providers revalidate?
Fee-for-service and MCO network providers enroll in PRSS and revalidate at least every five years. DMAS sends a notice at least 90 days before the enrollment period ends, with Gainwell reminder emails at 60 and 30 days. Revalidation is electronic only, through PRSS (see the Manage Revalidation panel). Missing it ends participation in both fee-for-service and MCO networks. Under DMAS's June 2026 CMS strategy, high-risk types (nursing facilities, DME, hospice, home health, prosthetic devices, doula services) move to a 3-year cycle on July 1, 2027. The 808 high-risk providers will be revalidated off-cycle from August to December 2027, and some moderate-risk providers in early 2028.