Reliable Medical billing services in Virginia
SwiftCare Billing provides medical billing services in Virginia for practices that bill Cardinal Care (Virginia Medicaid), Palmetto GBA for Medicare, and carriers like Anthem Blue Cross and Blue Shield. Pricing starts at 3% of collections. Month-to-month, 30 days’ notice.
- 98.4% Clean Claim Rate
- 175+ Providers
- 50+ Specialties
- 12+ Years
Virginia billing rules at a glance
| Item | Virginia |
|---|---|
| Medicaid program | Cardinal Care (Medicaid and FAMIS), run by the Department of Medical Assistance Services (DMAS) |
| Health plans | Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons in Virginia, Sentara Health Plans, UnitedHealthcare Community Plan |
| Provider portal | Virginia Medicaid Web Portal |
| Medicare A/B contractor | Palmetto GBA, Jurisdiction M (also NC, SC, WV) |
| Medicare DME contractor | DME MAC Jurisdiction C |
| Medicare timely filing | 12 months from date of service |
| Medicaid fee-for-service filing | 12 months from date of service; retroactive eligibility restarts the clock |
| Medicaid plan filing | Set by each plan; Aetna Better Health allows 365 days |
| Commercial prompt pay | 40 days from receipt of the claim (Va. Code 38.2-3407.15) |
| Surprise billing | State ban on balance billing for emergency and certain facility services, with a 30-day payment offer and arbitration (38.2-3445.01) |
| Workers’ compensation | Commission fee schedule; carriers have 45 days to pay an itemized bill |
What's changing for Virginia providers
Molina left, Humana arrived
On July 1, 2025, Humana Healthy Horizons joined Cardinal Care and Molina members moved to it. Some patients still carry old cards. A claim sent to Molina today is a denial waiting to happen. Foster care members also sit in a separate plan run by Anthem. We check the plan on the date of service.
Work requirements are on the way
DMAS issued guidance on community and work engagement requirements in February 2026, and a DMAS presentation puts the start near the end of 2026. Some adults will lose coverage. We re-verify eligibility at every visit, so you don’t treat patients the plan won’t pay for.
Taxonomy codes have to match your DMAS record
Aetna Better Health of Virginia expects the billing and rendering taxonomy codes on a claim to match the specialty registered with DMAS. A mismatch means a denial that has nothing to do with the care. We audit taxonomy before the first claim goes out.
Medical billing services in Virginia: how a claim gets paid
We’re a medical billing service provider that works inside your system. You can hand us everything or one piece, and the steps below show where each one sits.
3. Submit
Claim submission and tracking
Claims scrubbed, then tracked past day 40
5. Collect
Accounts receivable follow-up
Oldest claims first
Medical billing outsourcing for Virginia practices
As an outsourced medical billing company in Virginia, we take billing off your desk. You send encounters. We send back paid claims and a report. For many practices, medical billing outsourcing in Virginia replaces one full-time hire.
Physician and medical practice billing services in Virginia
Our physician medical billing services suit solo doctors and groups. Our medical practice billing services also cover clinics with several locations. Professional medical billing services should adapt to the practice, not the other way around.
Medical coding services in Virginia
AAPC-certified coders assign CPT, ICD-10 and HCPCS codes. Medical coding services in Virginia also mean staying on top of annual code changes, like the ICD-10-CM update that took effect October 1, 2026.
Medical billing and collections services in Virginia
Our medical billing and collections services chase unpaid claims and patient balances in order of age. Medicaid claims hit a 12-month limit, so old accounts get first call.
Healthcare revenue cycle management services in Virginia
Revenue cycle management is more than sending claims. As a revenue cycle management company in Virginia, we look at registration, eligibility and authorizations too, because that’s where most denials begin. These healthcare billing services cover the whole path from check-in to payment, and medical claims billing services are available on their own.
Getting credentialed and enrolled in Virginia
A provider who isn’t enrolled doesn’t get paid. In Virginia Medicaid, you enroll with DMAS first, then contract with each health plan. Our medical credentialing services cover every layer.
- NPI check and an attested CAQH profile
- Medicare enrollment through PECOS, processed by Palmetto GBA
- DMAS enrollment through the Virginia Medicaid Web Portal
- Credentialing with each Cardinal Care plan you choose
- Commercial plan applications
- Revalidation reminders
Virginia payers we work with
- Medicare: Palmetto GBA (Part A and B), DME MAC Jurisdiction C, and Medicare Advantage plans
- Cardinal Care: Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons in Virginia, Sentara Health Plans, UnitedHealthcare Community Plan
- Commercial: Anthem Blue Cross and Blue Shield, Aetna, Cigna, UnitedHealthcare
- Workers' compensation carriers
Specialties we support in Virginia
We bill 50+ specialties. Virginia practices often come to us in family practice, pediatrics, mental health, physical therapy, chiropractic and cardiology.
Works with the EHR you already use
We support 80+ systems, including Epic, athenahealth, eClinicalWorks, Tebra (Kareo) and AdvancedMD. We also connect to your clearinghouse and the Virginia Medicaid portal.
Practices we serve across Virginia
Virginia Beach, Norfolk, Richmond, Chesapeake, Arlington, Alexandria, Roanoke, Lynchburg, Charlottesville and Fredericksburg, plus the Shenandoah Valley and Southwest Virginia. SwiftCare Billing serves providers in all 50 states.
Why choose SwiftCare Billing in Virginia
- A team, not one biller. 200+ certified billers work on our clients' claims.
- Certified coders. AAPC-certified coders review the codes.
- U.S.-based staff. Your claims and patient data stay with a team in the United States.
- One person to call. Every practice gets a named account manager.
- Monthly reporting. You see collections, denials and A/R every month.
- Paperwork first. We sign a business associate agreement before we open a single record, and we report any breach as the agreement requires.
- Your data stays yours. If you leave, your claims and patient accounts go with you.
- Rule changes, flagged early. We track Virginia updates, like new Cardinal Care plans, and tell you before they reach your claims.
What it costs and how we start
Most practices pay between 3% and 8% of collections, depending on specialty, claim volume and payer mix. A free audit gives you a quote from your own claims.
- Send recent claims; we return a written audit in 5 business days
- Give us access to your EHR and clearinghouse
- We check your enrollment with Palmetto GBA, DMAS and each plan
- We review fee schedules and payer contracts
- You go live in 7 to 14 business days, with monthly reports after that
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FAQs
How much does a billing company charge in Virginia?
Fees depend on specialty, volume and payer mix. A pediatric practice with many Medicaid claims prices differently from a cash-heavy specialty. The audit looks at your actual claims and gives you a number, so you aren’t guessing.
Which Cardinal Care plans do you bill?
All five: Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons in Virginia, Sentara Health Plans and UnitedHealthcare Community Plan. We also handle credentialing with each one.
Who processes Medicare claims in Virginia?
Palmetto GBA, as the A/B MAC for Jurisdiction M. DME claims go to DME MAC Jurisdiction C. Medicare claims must be filed within 12 months of the date of service.
How long do I have to file a Virginia Medicaid claim?
Fee-for-service claims are due within 12 months of the service date. Retroactive eligibility or a third-party retraction can restart the clock. Health plans set their own limits, so check each plan’s manual.
How fast must Virginia insurers pay?
Carriers must pay a claim within 40 days of receiving it, unless the obligation to pay isn’t reasonably clear. Self-funded employer plans follow federal law instead. We track every commercial claim against that clock.
Does Virginia protect patients from surprise bills?
Yes. State law bars out-of-network providers from balance billing for emergency services and certain facility-based care. The carrier must offer a commercially reasonable payment within 30 days, and disputes go to arbitration.
Can you start credentialing and work in our EHR?
Yes to both. We handle enrollment with DMAS, each plan and commercial carriers, and we work inside more than 80 systems. You keep your EHR.
How soon can you take over our billing?
Go-live takes 7 to 14 business days after the audit, once we have access to your systems.
Let's look at your last 90 days of Cardinal Care claims
Tell us which Cardinal Care plans and commercial payers you bill. We’ll review your recent claims and send a written report within 5 business days.