Sentara Health Plans is Growing
Effective July 1, 2023, Sentara Health Plans Plan will assume the existing Virginia Premier agreements with Virginia Premier Providers. As of the merger effective date, Sentara Health Plans will assume all of Virginia Premier’s rights and obligations under the agreement.
Sentara Health Plans Plan, a Virginia non-profit corporation, shares the same values as Virginia Premier and merging with them will help solidify our efforts to ensure that we continue to offer exceptional care and service to our consumers, members, patients and communities. It also helps us to better anticipate and respond to changes in our industry and to identify opportunities for growth and innovation.
Starting July 1, 2023, Virginia Premier Medicaid will become a part of Sentara Health Plans.
- The Virginia Premier Medicaid product will now be branded Sentara Health Plans and the Virginia Premier name will no longer be in use for Medicaid. Medicaid member ID cards will use Sentara Health Plans, Group Number: VP.
- This change means that DMAS will remove Virginia Premier from their Medicaid documents, enrollment broker/Maximus, websites, health plan comparison charts, etc.
- As the CMS contracted DSNP program will end December 31, 2023, Virginia Premier D-SNP, Virginia Premier Advantage Elite, will remain a product of Virginia Premier.
Summary of business operations beginning on July 1
- Group Number VPs an important distinction enabling Sentara Health Plans to administer the provider agreements for benefits and claims payments.
- Submit all Group Number VP claims to Payer ID VAPRM
- Registration for PaySpan is required. To register, contact by email at providersupport@payspan.com or call 1-877-331-7154, option 1. You will receive the requisite registration code and can also request assistance with navigating the website. PaySpan is available Monday – Friday, 8 a.m. – 8 p.m.
- Generally, conducting business with Sentara Health Plans Group Number VP will remain the same as you have experienced historically with Virginia Premier. You will receive timely notice of any process changes in the future.
Provider Orientation Opportunities
We are hosting Virginia Premier/Sentara Health Plans Merger: Provider Orientation sessions one per week during the months of June and July.
Contracts
Combining Sentara Health Plans and Sentara Health Plans Group Number VP
At this time, contracts shall remain separate for the two product lines: Sentara Health Plans Medicaid and Sentara Health Plans, Group Number: VP. We foresee combining contracts but will ensure that both DMAS and Sentara Health Plans are able to administer the change efficiently and accurately for our provider partners. We will ensure timely notice.Participating providers in need of assistance related to contracting may contact network management at networkmgmt@sentara.com.
Important: Sentara Health Plans, Group Number: VP identifies legacy Virginia Premier provider agreements for claims adjudication.
Corporate Address
(For general health plan correspondence and deliveries. Not intended for claims submission or appeals. See Conducting Business Beginning July 1 for that information.)
U.S. Mail
Sentara Health Plans
PO Box 66189
Virginia Beach, VA 23466
Overnight Mail
Sentara Health Plans, Inc.
1300 Sentara Park
Virginia Beach, VA 23464
| Provider Scenario | |||
| Member Scenario | Provider Scenario Legacy VPHP Provider Never OHP Contract Accepted | undefined Legacy VPHP Provider Never OHP Contract Declined | undefined OHP Provider Never VP |
| Sentara Health Plans: Group VP | Provider Scenario YES | undefined NO | undefinedNO |
| Sentara Health Plans | Provider Scenario YES | undefined NO | undefined YES |
| Sentara Health Plans: Group VPNewborn | Provider Scenario YES | undefined NO | undefined NO |
| Virginia Premier: DSNP | Provider Scenario YES | undefined YES | undefined NO |
| Kaiser Permanente | Provider Scenario Requires contract w/Kaiser Permanente | undefined Requires contract w/Kaiser Permanente | undefined Requires contract w/Kaiser Permanente |
| Payer IDs | |||
| Payer IDs Group Number VP (Including newborns) | undefinedVirginia Premier (DSNP) | undefinedOptima Health | undefinedKaiser |
| Payer IDsVAPRM All Claims | undefinedVAPRM All Claims | undefined54154 – Professional/Medical 5415M – Professional/Behavioral Health 00453 – Institutional | undefinedContact Kaiser directly for Payer ID |
Identifying Members
Group Number VP Card Sample
- Sentara Health Plans Group Number VP members will receive their new ID cards in June.
- If a member presents with a legacy Virginia Premier ID card membership eligibility should be verified to confirm they are under Group Number VP.
- Group Number VP is an important distinction enabling Sentara Health Plans to administer the provider agreements for benefits and claims payments.
Sentara Health Plans Card Sample
Kaiser Permanente Card Sample
The health plan formerly known as Virginia Premier had a relationship with Kaiser Permanente that will continue beyond July 1, 2023, expanding to Sentara Health Plans members in Northern Virginia. Kaiser Permanente member IDs will be uniquely distinguished with their company logo.
Log on to www.providers.kp.org/mas to access information for members assigned to Kaiser Permanente. Member information will not be available on the Sentara Health Plans secure portal (Provider Connection). Attempts to search these members will produce the following message: “MSG*This member is part of the collaboration between Optima (VP) and Kaiser Permanente.”
FAMIS
MEDICAID
Medicare/DSNP
Virginia Premier D-SNP, Virginia Premier Advantage Elite, will remain the same. DSNP is contracted with CMS and remains effective through December 31, 2023
Key Contacts
The provider and member customer service numbers have been consolidated.
Provider/Member Customer Service: (800) 881-2166
- Select the health plan you are inquiring about:
- #3 Sentara Health Plans, formerly Virginia Premier (Group Number VP), then follow prompts to reach department
- #4 Sentara Health Plans, then follow prompts to reach department
Until further notice some departments can still be reached through the numbers you’ve dialed historically.
Group Number VP
- Transportation: (855) 880-3480
- Pharmacist Help Desk (including pre-authorization): (877) 779-2890
- Care Coordination: (800) 727-7536
- Provider Service Representative: Request support via email contactmyrep@virginiapremier.com
Sentara Health Plans
- Transportation: (877) 892-3986
- Pharmacist Help Desk: (844) 604-9165
- Care Coordination: (866) 546-7924
- Network Educator: (product and service updates, escalations) (877) 865-9075, Option #2
- Additional phone numbers
Conducting Business Beginning July 1, 2023
Group Number VP
Clinical Guidelines: The clinical guidelines for Group Number VP will not change to align to Sentara Health Plans at this time. While we are integrating, we are reviewing these policies to ensure we are taking the best steps for members and providers. During this period providers will continue to operate under the prior standards of each plan unless otherwise notified.
Viewing Eligibility: Members with Group Number VP will be distinguished as Sentara Health Plans (formerly Virginia Premier) on the DMAS portal. To verify directly through the health plan, you should use the former Virginia Premier portal, which remains available at https://www.virginiapremier.com/providers/
Claims Submission:
- Electronic Claims Submission: We accept claims through any clearing house that can connect through Availity and Change Healthcare.
- Mail Paper Claims to: PO Box 5550, Richmond VA, 23220
Timely Filing: Please refer to your contract for your Practices Timely Filing Requirements. You have 365 days from the date of service to submit any corrections, reconsiderations, and/or appeals.
Turnaround time for clean (correctly submitted) claims:
- Auto Adjudication 6 days
- Manual Adjudication 19 days
Reconsiderations - For denied claims must be sent to Sentara Health Plans Group: VP within 365 days of the last day of service. The Claim Adjustment/reconsideration Form can be accessed at https://www.optimahealth.com/providers/virginia-premier/
Appeals – May be submitted in writing within 365 days from the date of service for claims appeals. Clinical appeals must be submitted within 60 days of notice of denial. Detailed information and supporting written documentation should accompany the appeal. A decision will be rendered within 30 business days of receipt of the appeal request, with a 14-day extension if it is in the best interest of the member.
Mail to:
Sentara Health Plans Appeals and Grievances
PO Box 6253
Glen Allen, VA 23058
Appeal Email: memberappeals@sentara.com
Grievance Email: complaints@sentara.com
Phone: (844) 434-2914
Fax: (866) 472-3920
Member Operations: (800) 881-2166
Authorizations:
Group Number VP
Existing Authorizations: Providers will experience no changes to authorizations that are approved and in progress, until further notice. The systems and guidelines supporting the authorizations for Group Number VP will remain the same. New authorization numbers will not be required on July 1.
New Authorizations: New authorizations are triggered by member eligibility. If Group Number VP member is eligible, use the existing authorization process you have used historically with Virginia Premier.
Joining the Network: New groups joining the network will join under Sentara Health Plans.
If you are interested in joining the LTSS network, please contact Centipede for additional information.
To Join Our LTSS Network
CENTIPEDE Health Network
Phone: (855) 359-5391
Fax: (866) 421-4135
Email: joincentipede@heops.com
CENTIPEDE Credentialing
CENTIPEDE Health
P.O. Box 291707 Nashville, TN 37229
Facility and Ancillary Providers: Contact Network Management at (877) 865-9075 to inquire about the contracting process.
To add a new provider to a practice, please submit a Provider Update Form. Please review the provider credentialing requirements prior to completing your submission.
Provider Manual Medicaid Supplement
Payer ID: VAPRM (all claims)
Sentara Health Plans
Conducting business with Sentara Health Plans will remain the same except for the following:
Appeals – May be submitted in writing within 365 days from the date of service for claims appeals. Clinical appeals must be submitted within 60 days of notice of denial. Detailed information and supporting written documentation should accompany the appeal. A decision will be rendered within 30 business days of receipt of the appeal request, with a 14-day extension if it is in the best interest of the member.
Mail to:
Sentara Health Plans Appeals and Grievances
PO Box 6253
Glen Allen, VA 23058
Appeal Email: memberappeals@sentara.com
Grievance Email: complaints@sentara.com
Phone: (844) 434-2914
Fax: (866) 472-3920
Member Operations: (800) 881-2166
Submitting Provider Updates
Effective July 1, 2023you may submit changes related to the legacy Virginia Premier Health Plan at Update Your Information | Providers | Sentara Health Plans for the following request types:
- Virginia Premier DSNP
- Updates to legacy Virginia Premier Health Plan data to support claims processing and/or reprocessing efforts for all products prior to 7/1/2023.
If you are a participating provider, and need additional assistance related to provider data updates, please email: pustatus@sentara.com
Sentara Brand Evolution
We are introducing our new name, Sentara Health, which reflects our enhanced focus on promoting the overall health and well-being of our consumers—our patients, members, and communities—who are at the center of everything we do. It also represents our deepening alignment between our healthcare services and health plans. We are practicing the future of healthcare today by providing healthcare that is simple, seamless, personal, and more affordable.
In 2023, Optima Health and Virginia Premier brands unifying were unified under Sentara Health Plans. This change shows our steadfast commitment to our members and the communities we serve. The new brand identity is a representation of our growth and our promise to continue innovating and adapting in the ever-changing healthcare industry.
We will continue to go by the name people call us, Sentara, a name and brand our consumers trust.
While our brand is evolving, our mission remains the same: We Improve Health Every Day.