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Virginia Department of Medical Assistance Services
Provider Services
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  •  Provider Enrollment
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  •  Provider Enrollment
    •  New Enrollment
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    Welcome

    Welcome to the Virginia Department of Medical Assistance Services Online Provider Enrollment System

    Providers should review enrollment requirements using the Enrollment Pre-Checklist below to determine required documentation by Medicaid Program, Enrollment Type, and Provider Type and Specialties. The online Provider Enrollment System requires information and guides you based on this information

    When you submit your enrollment application, you may check the status and respond to Return to Provider (RTP) requests for additional information needed to continue the review of your enrollment application.

      Please click the “Start” button to begin the enrollment process.  The application will automatically save each time you click “Continue”. 

      Enrollment Pre-Checklist
      Please select from the below parameters to generate a checklist enlisting the credentials and required documentation for your enrollment application. All information must be complete and current for processing.
      Generate Pre-Checklist
      Registration

      IMPORTANT NOTICE: Save time and prevent duplicate enrollments. If you are enrolling as an Individual within a Group (IG) or Ordering, Prescribing and Referring (OPR) provider, please check your enrollment status with MES of Virginia by accessing the latest active provider extract provided at the following link: Check Enrollment Status

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      If you are listed on this extract, and actively enrolled as an IG or OPR, you are not required to complete an additional enrollment, you may utilize the Service Location Id provided to associate to a new Group or Facility location on the Secure Provider Portal.

      If you are not listed on the extract continue registering below to be assigned a unique enrollment Application Tracking Number (ATN). An email confirmation will be sent with the ATN. If you do not submit your enrollment right away, you can use this ATN and password to resume your enrollment application later.

      General
      Initial Enrollment Information
      Provider Information
      The Provider Name must be the current name on tax, corporation, or other legal documents. The legal name and Provider Federal Tax Identification Number (TIN) must match the information on the W-9 for businesses and Internal Revenue Service records for individuals.

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      This provider enrollment application is for the Department of Medical Assistance Services of Virginia program(s). If your enrollment includes a request to participate in one or more of the Virginia Medicaid Managed Care Organizations, your enrollment application and supporting documentation will be forwarded to those selected organizations. Please select from program options below:
      Please select the programs to which you are applying. You must choose at least one program.
      General Credential Information
      Please list the other names under which you have been known.
      IDNameFirst NameMiddle Name Effective DateEnd DateEdit
      Please select your place of birth.
      Contact Information
      Home Address
      DISCLAIMER

      The website is provided as a convenience to providers, members and stakeholders of State Medical Assistance Program. Despite our best intentions to maintain complete and accurate information, discrepancies may sometimes occur and materials on the site may not be consistent or up-to-date with current program guidelines. If in doubt, please contact Customer Service.

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      WEBSITE REQUIREMENTS

      PRIVACY AND SECURITY

      When logging in to the application for the first time, you may be asked if you are using a personal or a public computer. Please use caution while answering this question as the privacy and security required to protect healthcare data could be impacted by your selection.


      BROWSER SUPPORT AND TESTING

      The Gainwell Technologies Medicaid Management Solutions and Healthcare Portals support browsers meeting the World Wide Web Consortium (W3C) Hypertext Markup Language (HTML) 5 specification. Support is based solely on HTML 5 compatibility regardless of other factors, such as browser market share.

      Gainwell develops code to conform to the HTML 5 standard and compatibility is confirmed through rigorous testing. The Gainwell testing team conducts verification of product developed pages against Microsoft Edge, Google Chrome, and Safari. In the event a defect is identified, by Gainwell or a client, it will be evaluated and managed via the product defect management process.

      The browser support of various commercial off-the-shelf (COTS) tools, such as workflow, business rules engine, or file transfer systems is based on the browser capabilities defined by the specific software vendor.

      As the HTML 5 specification evolves, Gainwell will support minor version updates within one year of release. The current specification is HTML 5.2 and was published on 12/14/2017.


      ACCESSIBILITY AND AMERICANS WITH DISABILITIES ACT (ADA) COMPLIANCE

      Gainwell is committed to making its electronic and information technologies accessible to people with disabilities. We strive to meet or exceed the requirements of Section 508 of the Rehabilitation Act (29 U.S.C. 794d), as amended in 1998 as well as the Web Content Accessibilities Guidelines (WCAG) Version 2.1.

      Section 508 is a federal law that requires agencies to provide people with disabilities equal access to electronic information and data comparable to those who do not have disabilities, unless doing so would impose an undue burden on the agency. The Section 508 standards are the technical requirements and criteria used to determine whether the agency is meeting the requirements of this law.

      The Web Content Accessibility Guidelines (WCAG) are part of a series of web accessibility guidelines published by the Web Accessibility Initiative (WAI) of the World Wide Web Consortium (W3C), the main international standards organization for the Internet. They are a set of recommendations for making Web content more accessible, primarily for people with disabilities—but also for all user agents, including highly limited devices, such as mobile phones. WCAG 2.0, was published in December 2008 and became an ISO standard, ISO/IEC 40500:2012 in October 2012. WCAG 2.1 became a W3C Recommendation in June 2018.


      SCREEN RESOLUTION

      It is recommended that screen resolution should be a minimum of 1024 x 768.


      DOCUMENT VIEWING AND DATA EXPORTS

      Some features within the product produce information in either pdf or xls format. For viewing of this information, Adobe Acrobat and/or a Microsoft Office viewer may be required.


      COOKIES

      Like most commercial websites, the product may also use what is known as "cookie" technology. A "cookie" is an element of data that a website can send to your browser when you link to that website. It is not a computer program and has no ability to read data residing on your computer or instruct it to perform any step or function. By assigning a unique data element to each visitor, the website can recognize repeat users, track usage patterns and better serve you when you return to that site. The cookie does not extract other information about you, such as your name or address.

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      PRIVACY POLICY

      Enterprise Online Privacy Statement


      PRIVACY AND DATA PROTECTION AT PORTAL WEBSITES

      This policy has been updated to protect personal data in accordance with requirements set forth in the General Data Protection Regulation (GDPR), which took effect on May 25, 2018. At Medicaid HealthCare Payer Portal websites our commitment to privacy goes beyond the minimum legal and regulatory requirements. We strive for best-in-class data protection and privacy management, which requires a sound data privacy governance structure and an effective data privacy compliance and best practices program to ensure we meets ever-changing and increasingly-complex regulatory standards and all contractually agreed privacy obligations. Medicaid HealthCare Payer Portal websites Global Privacy and Data Protection Office has strategic and operational responsibility for this program, which is adequately resourced and appropriately organized to ensure the policies and compliance processes, technology and physical controls and security we rely upon to govern the collection, use, storage and transfer of personal data all over the world meets statutory and regulatory requirements. Therefore, Medicaid HealthCare Payer Portal websites approach is to coordinate the contribution of several corporate disciplines - including ethics and compliance, legal, human resources, and information and physical security - to achieve our "best in class" data protection and privacy management objectives.

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