Medical Billing Services
in Virginia Beach, VA

Since July 1, 2025, five health plans serve Cardinal Care members statewide, Virginia Beach included: Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons in Virginia, Sentara Health Plans and UnitedHealthcare. Humana joined that year, and Molina left the program. Each plan sets its own filing window in its provider manual. Anthem HealthKeepers Plus, for example, gives 365 days from the date of service for original claims. Qualigenix keeps a filing calendar for each plan and sends fee-for-service claims to DMAS inside its 12-month limit. Authorization lists also differ by plan, so our prior authorization team works from the list of the plan that will pay.

All five plans also run Medicare dual eligible special needs plans (D-SNPs), and Virginia requires them to operate as fully integrated plans. Under exclusively aligned enrollment, the D-SNP a full-benefit dual member picks decides which company handles their Cardinal Care benefits. Qualigenix checks D-SNP enrollment before billing, so the Medicare and Medicaid parts of the claim go to the same company. For a fee-for-service crossover, DMAS can pay within six months after Medicare decides a timely filed claim, and we track that window claim by claim.

Virginia's 40-day prompt-pay rule, balance-billing protections and DMAS enrollment apply the same way in every city. Our page on Virginia medical billing rules explains how Qualigenix handles them statewide.

Qualigenix sends Virginia Beach Medicare Part B claims to Palmetto GBA, the Jurisdiction M contractor for Virginia, within Medicare's 12-month filing limit. Medicare Advantage needs extra checking here. Since January 1, 2026, Sentara Health Plans no longer offers its non-dual Medicare Advantage plans, though its D-SNP continues, so a patient still carrying an old Sentara Medicare card is re-verified before the visit. TRICARE East is administered by Humana Military, with claims processed by PGBA, and TRICARE expects claims within one year of the date of service. On commercial claims, Virginia requires carriers to pay clean claims within 40 days and to flag a defect within 30 days. Qualigenix follows up on every claim against both dates.