Credentialing in Virginia
Soft Home Global provides payer enrollment, revalidation and follow-up for Virginia practices and billing companies at $2,300 per seat per month. Full time, worked during Virginia business hours, inside your own system.
What is specific to Virginia
Cardinal Care moved most Virginia Medicaid members into managed care plans, while practices in northern and coastal Virginia also carry heavy TRICARE and federal employee health benefit volume.
Virginia’s Medicaid programme is Cardinal Care (Virginia Medicaid). Practices with a meaningful Cardinal Care (Virginia Medicaid) mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
What a credentialing seat does in Virginia
Applications, revalidations and payer follow-up, with every enrollment's status visible.
Cardinal Care (Virginia Medicaid) is not one enrollment but one per plan, and every one of them has a revalidation date that stops payment when it passes. That calendar is the work.
- Initial applications prepared and submitted
- Revalidations tracked ahead of the deadline
- CAQH kept current
- Payer follow-up until an effective date is issued
- Status of every enrollment visible to you
- Worked during Virginia business hours, not queued overnight
For the statute behind all of this — Virginia’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the Virginia billing page.
Cardinal Care (Virginia Medicaid), in practice
Virginia Medicaid runs under one unified brand, Cardinal Care, with managed care (Cardinal Care Managed Care) delivered by five MCOs: Aetna Better Health of Virginia, HealthKeepers, Inc. (Anthem HealthKeepers Plus), Humana Healthy Horizons in Virginia, Sentara Community Plan, and UnitedHealthcare of the Mid-Atlantic, Inc. Source
Workers' compensation is billed off a mandatory, region-specific state fee schedule rather than 'prevailing community rate': Va. Code § 65.2-605 defines six 'medical communities' (Northern, Northwest, Central, Eastern, Near Southwest, Far Southwest, assigned by ZIP code) and provides that 'Separate initial Virginia fee schedules shall be established for fee scheduled medical services ... within each of the medical communities,' with 'The Commission's regulations that establish the initial Virginia fee schedules shall be effective on January 1, 2018.' The same CPT code pays differently depending on which of the six regions the service was rendered in. Source
For enrolment that is not a detail, it is a second application. A carved-out benefit is administered by a different organisation, which credentials separately, on its own timetable, and a provider who is live everywhere else can still be out of network for that one service without anybody noticing until the first claim is denied.
Working Virginia hours
Virginia runs on Eastern time, 10 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 7pm to 3am, and 6pm to 2am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Virginia hours and nobody else’s.
What it costs in Virginia
$2,300
Per seat, per month, in US dollars — $27,600 a year for one full-time person, forty hours a week, on Virginia hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Virginia run $1,550 to $2,600; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in Virginia
About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.
Questions
Do you work with Virginia practices?
Yes. Virginia accounts are worked during Virginia office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about Virginia?
Cardinal Care moved most Virginia Medicaid members into managed care plans, while practices in northern and coastal Virginia also carry heavy TRICARE and federal employee health benefit volume.
When does a Virginia payer have to pay a clean claim?
40 days from receipt of the claim (no separate electronic/paper deadline in the statute). A claim sitting past that is not merely late, it is late against a statute, and the follow-up call changes from "when might this be paid" to "this passed your statutory window on a specific date".
How much does credentialing cost in Virginia?
$2,300 per seat per month — $27,600 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our Virginia queue?
Virginia is on Eastern time, 10 hours behind Rawalpindi. The shift here runs 7pm to 3am so your seat is at a desk for your full working day, shifting to 6pm to 2am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle Cardinal Care (Virginia Medicaid) as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. Cardinal Care (Virginia Medicaid) has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
What is the minimum commitment, and how quickly can somebody start?
One seat for one month, cancellable on thirty days notice, and about a week from a signed agreement to a person working your queue. The week of training is not billed. The steps are at softhomeglobal.com/how-it-works.
Is our patient data safe offshore?
A Business Associate Agreement is signed before anyone has access, and the work happens in your own system under a login you issue, so every action is attributable to a person in your audit trail. The controls are listed at softhomeglobal.com/security.
Next step
One seat on your Virginia work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com