Department of Corrections eligibility update


You may have recently received notice from the Virginia Department of Corrections (DOC) regarding billing and payment for inpatient hospitalization services provided to the DOC offender population.  The passage of HB5001 expanded eligibility of Medicaid benefits for individuals in the Commonwealth in accordance with the Patient Protection and Affordable Care Act (PPACA).  With this change, a significant portion of the DOC population will become newly eligible for medical assistance benefits. 


Therefore, for most of the inpatient hospitalization services administered on or after January 1, 2019. Medicaid should be the primary payer on the claims.  The DOC is proactively working with the Virginia Department of Medical Assistance Services (DMAS) and the Virginia Department of Social Services (VDSS) to enroll all eligible offenders into the Inpatient Hospitalization Medicaid aid category.


Effective January 2, 2019, DOC Inpatient Hospitalization claims should be filed directly to Medicaid, as they will automatically deny if submitted to Anthem.  If the claim is denied by Medicaid, it should be filed to Anthem for payment, following your standard process.  


Timely filing

Effective immediately for offenders covered by Anthem’s Inmate Services Program, claims for Covered Services rendered to Anthem Covered Individuals must be submitted within 12 months of the date of service.  Claims that have been denied by Medicaid and must be resubmitted to Anthem may be reviewed on a case by case basis if outside of the timely filing period.

If you have questions, please reach out to your Anthem representative.




Featured In:
December 2018 Anthem Provider Newsletter - Virginia