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  • Dmas 1001

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THIRD PARTY REPORTING FORM Recipient ID (Medicaid #): Recipient Name: Insurance Company and Address: Policy Number: Group Number: Effective Dates: Subscriber: Employer Name and Address: Name/Address/Phone.

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Department of Medical Assistance Services (DMAS): The agency that administers the Medicaid program in Virginia. Department of Social Services (DSS): The agency responsible for determining eligibility for medical assistance and the provision of related social services.

About the Agency The mission of the Virginia Department of Medical Assistance Services (DMAS) is improving the health and well-being of Virginians through access to high-quality health care coverage.

The purpose of Virginia Medicaid is to improve the health of people in Virginia who might otherwise go without medical care for themselves and their children. There is no enrollment fee or premium for Medicaid coverage if you are eligible. Low co-pays are charged for some Medicaid services.

For provider enrollment inquiries, contact the Virginia Medicaid Provider Enrollment Helpdesk by phone at 804-270-5105 or 888-829-5373. For managed care assistance, call 800-643-2273 or email ManagedCareHelp@dmas.virginia.gov.

These are the health plans Medicaid and FAMIS members can choose: Aetna Better Health of Virginia. Anthem HealthKeepers Plus. Molina Healthcare. Optima Health. UnitedHealthcare Community Plan.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232