Va. DMAS Hospice Provider Manual ch. V, Electronic Submission Of Claims

Electronic billing using Electronic Data Interchange (EDI) is an efficient way to submit

Medicaid claims. Providers use EDI software that enables the automated transfer of data

in a specific format following specific data content rules directly to DMAS. For more

information, go to https://vamedicaid.dmas.virginia.gov/edi.

The Virginia Medicaid Enterprise System (MES) is HIPAA-compliant and, therefore,

supports all electronic filing requirements and code sets mandated by the legislation.

MES will accommodate the following Electronic Data Interchange (EDI) transactions

according to the specifications published in the ASC X12 Implementation Guides version

5010.

▪

837P for submission of professional claims

▪

837I for submission of institutional claims

▪

837D for submission of dental claims

▪

276 & 277 for claims status inquiry and response

▪

835 for remittance advice information for adjudicated (paid and deni

ed)

▪

270 & 271 for eligibility inquiry and response

Although not mandated by HIPAA, DMAS has opted to produce an unsolicited 277

transaction to report information on pended claims.

If you are interested in receiving more information about utilizing any of the above

electronic

transactions,

your

office

or

vendor

can

obtain

the

necessary

information at our fiscal agent’s website: https://vamedicaid.dmas.virginia.gov/edi#gsc.t

ab=0

The mailing address, phone number and fax number for the EDI program are:

EDI Coordinator

Virginia Medicaid Fiscal Agent

P.O. Box 26228

Richmond, Virginia 23260-6228

Phone: (866) 352-0766

Fax number: (888) 335-8460

The email for technical/web support for EDI is MESEDISupport@dmas.virginia.gov.