MedicaidPrior AuthHigh impact
Submitting Retrospective Service Authorization Requests for Retroactive Eligibility
Virginia Medicaid - DMAS·VA·Prior Authorization
Effective date
Aug 24, 2026
We identified it
Sep 11, 2026
Summary
Virginia Medicaid now requires providers to obtain retrospective service authorizations for services rendered to individuals approved for retroactive eligibility. Providers must submit these authorization requests within 90 calendar days of the member's Medicaid eligibility determination date and include them with claims submissions. Requests submitted after 90 days will be denied for timeliness.
Action Required
By August 24, 2026: Billing team must implement the following workflow changes: (1) When processing claims for retroactively eligible Medicaid members, verify the member's eligibility determination date using MediCall (1-800-884-9730) or the Virginia Medicaid Web Portal ARS (https://vamedicaid.dmas.virginia.gov/); (2) Calculate the 90-calendar day deadline from the eligibility determination date; (3) Submit retrospective service authorization requests to the appropriate managed care plan or DMAS (Acentra Health for behavioral health/medical: 1-804-622-8900 or https://vamedicaid.dmas.virginia.gov/sa) within the 90-day window; (4) Include the authorization with the claim submission; (5) Track authorization submission dates in billing system to prevent timeliness denials; (6) Flag any claims requiring retroactive authorization that fall outside the 90-day window for provider communication before billing attempt. Failure to obtain and submit retrospective service authorizations within 90 days will result in claim denials. Also ensure provider enrollment information is current in PRSS (Provider Services Solution) to avoid payment disruptions.