Virginia Premier Prior Authorization Form - Virginia Premier Health Plan is an additional trade name for Sentara Health Plans Optima Behavioral Health is an additional trade name for Sentara Behavioral Health Services Inc Optima Health Maintenance Organization HMO products and Point of Service POS products are issued and underwritten by Sentara Health Plans
For urgent requests please submit through the JIVA portal or call 1 888 251 3063 Outpatient and Inpatient Procedure Service Request Form Facility Hospital facility Name NPI Tax ID
Virginia Premier Prior Authorization Form
Virginia Premier Prior Authorization Form
PRIOR AUTHORIZATION REQUEST FORM Is this REQUEST for: EOC ID: Virginia Premier Opioid Phone: Fax back to: 866-754-9616 Medallion 855-872-0005 VPEPLUS 844-838-0711 Short-Acting Opioid Long-Acting Opioid BOTH (check all that apply) Prior Authorization is required for: 1) All Long Acting Opioids
Use the Virginia Premier provider forms library to access claims and EDI forms contracting and credentialing forms as well as pharmacy forms
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Prior Authorization List Search Some drugs and or procedures require prior authorization before Virginia Premier will cover the cost W9 Submission Please send your completed W9 to PDMsupport sentara Provider Inquiry Line Call our Provider Inquiry Line at 1 800 727 7536 TTY 711 8 00 am to 6 00 pm Mon Fri
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By logging in to this portal I affirm that I have read understand and agree to abide by the following terms and conditions I certify I am a health care provider an employee of a health care provider a business associate of a health care provider or an employee of a business associate and the purpose of my access to any Virginia Premier System is related to the provision or payment of
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Search Prior Authorization List PAL 1 Please select your plan Optima Community Care VP Medicaid for dates of service on or before 12 31 2023 formerly Virginia Premier Elite Plus FAMIS Medallion Virginia Premier Advantage Elite for dates of service on or before 12 31 2023 HMO D SNP 2 Input procedure code or description
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Virginia Premier s Provider Portal is a safe and secure tool that gives providers quick and easy access to Submit DME Home Care Therapy Outpatient and emergent Inpatient authorizations Verify Member Eligibility Check Claim Status and View Details Check Authorization Status and View Details
Documents and Forms. Find a Provider or Pharmacy. Prescription Drugs and Pharmacy. Access pharmacy and prescription drug related resources. ... Optima Family Care (formerly Virginia Premier) Member Handbook. PDF, 2 MBLast Updated: 07/24/2023. PDF, 2 MBLast Updated: 07/24/2023. Optima Health Community Care (formerly Virginia Premier) Member ...
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Optima Family Care Optima Health Community Care Optima Medicare Value HMO Optima Medicare Prime HMO Optima Medicare Salute HMO and Optima Community Complete HMO D SNP Prior Authorization Forms Addiction and Recovery Treatment Services ARTS DMAS Provider Attestation Form PDF 628 KB Last Updated 03 28 2023
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Virginia Premier Prior Authorization Form
Virginia Premier s Provider Portal is a safe and secure tool that gives providers quick and easy access to Submit DME Home Care Therapy Outpatient and emergent Inpatient authorizations Verify Member Eligibility Check Claim Status and View Details Check Authorization Status and View Details
For urgent requests please submit through the JIVA portal or call 1 888 251 3063 Outpatient and Inpatient Procedure Service Request Form Facility Hospital facility Name NPI Tax ID
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