Medical Billing Services in Virginia
Remote medical billing and revenue cycle management for Virginia practices that bill Virginia Medicaid, Medicare, Medicare Advantage and commercial plans such as Anthem HealthKeepers. Cleaner claims, fewer denials and faster payments, with no upfront cost.
A billing team that knows Virginia payers
Virginia combined its Medicaid managed care programs under Cardinal Care, with most members in a handful of statewide plans. Anthem and Sentara lead the commercial market, while CareFirst covers Northern Virginia and a large military population brings TRICARE into the payer mix.
Provider Concerns handles that work for you, remotely. Our team verifies coverage and plan type before each visit, codes and scrubs every claim, submits it electronically, posts payments and works every denial by reason code. You get a single point of contact and monthly reports on collections, denials and days in A/R, so you always know where your revenue stands.
We work with solo physicians, specialty groups, clinics and multi-location practices across Virginia, including Virginia Beach, Chesapeake, Arlington, Norfolk, Richmond and Roanoke. Because we work inside your existing EHR or practice management system, there is nothing to install and no disruption to your front desk. Learn more about our medical billing, denial management, claims processing and revenue cycle management services.
What we handle for Virginia practices
- Medicare Part B claims through Palmetto GBA (Jurisdiction M)
- Virginia Medicaid claims, mostly through managed care plans
- Medicare Advantage plans, with plan-level authorization tracking
- Commercial payers such as Anthem HealthKeepers, Sentara Health Plans and Aetna
- DME claims to CGS (DME Jurisdiction C)
- Eligibility checks, coding review, A/R follow-up and patient statements
- Monthly reporting on collections, denials and days in A/R
Virginia billing rules at a glance
The payer rules that shape how Virginia claims get paid. Plan contracts can differ, so we confirm each payer's current requirements during onboarding.
Medicaid program
Virginia Medicaid (Cardinal Care), paid mostly through managed care plans
Medicaid filing limit
Set by the state program and by each managed care plan contract; we confirm every payer's current window during onboarding
Medicare contractor (Part A/B)
Palmetto GBA, Jurisdiction M
Medicare filing limit
12 months (one calendar year) from the date of service
DME contractor
CGS (DME Jurisdiction C)
Major commercial payers
Anthem HealthKeepers, Sentara Health Plans, Aetna, UnitedHealthcare and Kaiser Permanente
Revenue cycle services for Virginia practices
Pick one service or hand us the whole revenue cycle. Either way, you keep full visibility into every claim.
Medical billing
Charge entry, claim scrubbing and electronic submission to every Virginia payer you work with.
Learn more →Claims processing
Clean claims built to each payer's edits, so fewer are rejected before they are ever reviewed.
Learn more →Denial management
Every denial worked by reason code, corrected, appealed and tracked until it is paid.
Learn more →Revenue cycle management
Eligibility, coding review, payment posting, A/R follow-up and monthly reporting in one service.
Learn more →Common Virginia denials and how we prevent them
Most denials are preventable. These are the ones we see most often for Virginia practices, and the checks we run to stop them before a claim goes out.
Wrong Medicaid plan
Virginia Medicaid members can switch managed care plans, and claims sent to the old plan are denied. We re-check plan assignment before each visit and on every rejected claim.
Medicare Advantage vs. Original Medicare
Patients move between Original Medicare and Medicare Advantage plans during open enrollment. We verify the plan at every visit so claims don't go to Palmetto GBA when a private plan should be billed.
Missing prior authorization
Many Virginia plans require approval for imaging, procedures and specialty visits. We request and track authorizations before the date of service.
Coding and modifier errors
Bundling edits, missing modifiers and diagnosis codes that don't support medical necessity are among the most common avoidable denials. Certified coders review claims before they go out.
Timely filing
Medicare, Virginia Medicaid and commercial plans each set different deadlines. We track every open claim against its payer's window so nothing ages out.
Coordination of benefits
Secondary coverage, workers' comp and auto claims need the right payer order. We confirm it up front and bill secondary payers as soon as the primary pays.
Getting started is simple
No long setup and no upfront cost. Here is how Virginia practices move their billing to Provider Concerns.
Free billing review
We look at your collections, denials and A/R to find where revenue is being lost.
Payer setup
We confirm your Virginia Medicaid, Medicare and commercial enrollments and each payer's rules.
Clean claims
We verify eligibility, code, scrub and submit claims inside your current system.
Follow-up & reports
Denials and aging balances are worked every week, with monthly reporting.
Medical billing across Virginia
We support practices statewide, from large metro groups to rural clinics. Billing is handled online, so location is never a barrier.
Specialties we bill for in Virginia
Frequently asked questions about medical billing in Virginia
Do you bill Virginia Medicaid?
Who is the Medicare contractor for Virginia?
Which commercial insurance plans do you work with in Virginia?
Can you support practices in Virginia Beach and other Virginia cities?
What is the Medicaid timely filing limit in Virginia?
How much does medical billing cost for a Virginia practice?
Ready to get paid faster in Virginia?
Get a free billing review. We'll look at your collections, denials and A/R and show you exactly where revenue is being lost.