Virginia Department of Medical Assistance Services
Myers and Stauffer LC is a contractor for the Virginia Department of Medical Assistance Services (DMAS), the agency that administers the Medicaid Program for the Commonwealth of Virginia. This web site is intended to provide an efficient means to obtain Medicaid program documentation and information relating to the provider categories or subjects listed on the menu.
DMAS General Provider Auditing
The General Provider Auditing includes reviews of service providers that participate in the Virginia Medicaid program. Reviews include service providers under multiple waiver types and supported programs, such as Commonwealth Coordinated Care Plus (CCC+) Waiver, the Developmental Disabilities Waivers, Dental services, Physician services, etc.
Important Contact Information
Phone: 804.270.2200
Fax: 844.803.7836
Email: VAProgramIntegrity@mslc.com
Contract Manager
Travis Melton, CPA
Senior Manager
100 Eastshore Drive, Suite 200
Glen Allen, Virginia 23059
Standard Review Process
- Provider is notified approximately 3 weeks in advance of the review.
- An entrance conference is held at the onset of the review, in person or telephonically.
- A preliminary review of the documentation available for review is conducted.
- An exit conference is held at the completion of the first stage of the review.
- A Preliminary Report is issued after DMAS approval. The Preliminary Report may include a Preliminary Claims List, a Preliminary Service Log and a Preliminary Discrepancies Letter.
- If discrepancies have been identified on the Preliminary Report, the Provider is afforded 30 days to respond to the Preliminary Report. This may include additional documentation and information in response to the preliminary discrepancies that have been identified on the report.
- The Provider’s response to the Preliminary Report is then reviewed to determine if the additional documentation and information submitted resolves the discrepancies identified on the Preliminary Report.
- If discrepancies remain after review of the Provider’s response to the Preliminary Report, an Overpayment Report is issued after DMAS approval. (If the Provider does not submit a response within 30 days of the Preliminary Report, an Overpayment Report will be issued after DMAS approval.) The Overpayment Report may include an Overpayment Claims List, an Overpayment Service Log and an Overpayment Letter.
- The Overpayment Letter includes information on the Provider’s appeal rights, if the Provider disagrees with the findings within the Overpayment Report.
For Questions Regarding Preliminary and Overpayment Letters
Brandy Coleman, MHA, CHC, CPhT
Jill Tyler, LCSW
Ryan Rios, CFE
Shelly Verougstraete, CPA
Example Review Documents
Provider Guide to Understanding Your Report
Your letter includes a narrative explanation of each discrepancy or error code. This narrative explanation provides the factual basis and relevant authority for each discrepancy or error code.
You have been provided with a “Claims List” and a “Service Log”, if needed. The “Claims List” includes: facility listing of claims reviewed, by recipient, identifying the discrepancy(s) or error(s) for each respective claim. The “Service Log” is supplemental information only for particular provider types, and has specific details for each recipient, for each date of service, that is included in the “Claims List.” To understand additional detail of the discrepancy(s) or error(s) identified in your “Claims List,” please reference each recipient’s respective “Service Log,” if needed.
Each recipient’s “Service Log” will identify the services noted during our review, according to your documentation, applicable to the claim dates of service from the facility “Claims List.” The services noted on the “Service Log” represent our understanding of all documentation provided by you, to us, during our review for the applicable dates of service. If a discrepancy or error has been identified in a service, it will be so noted in the column with a corresponding code number to the discrepancy or error code number listed on “Claims List.”
References to Policies, Manuals, and Regulations
Electronic Code of Federal Regulations (Title 42 Public Health)
Virginia Administrative Code (Title 12 Health)
How to Submit Payment to DMAS Fiscal Division
- If you do not appeal the finding(s) identified in your overpayment letter and are unable to submit payment in full within 30 days of the letter, you should immediately request an extended repayment plan from DMAS fiscal division.
- If a provider does not respond to the overpayment letter by repaying the amount in full, by requesting an extended repayment schedule, or by filing a notice of appeal, DMAS must take further action to collect.
- To discuss repayment options available to you, please call the DMAS Fiscal Accounts Receivable Unit at 804-786-5433.
- Check payments can be remitted to the following address:
Department of Medical Assistance Services
600 E. Broad Street, 8th Floor
Richmond, Virginia 23219
Attn: Accounts Receivable
- A toll-free Helpline is available at 1-800-552-8627 to assist you with any problem or question you may have regarding billing.
- For further information regarding Medicaid policy or guidelines, you may access the DMAS website at www.dmas.virginia.gov.
How to Request an Appeal
First Level of Appeal (Informal)
- You must file your written notice of appeal with the DMAS Appeals Division within 30 days of the date of your overpayment decision letter.
- Your notice is considered filed when it is date stamped by the DMAS Appeals Division.
- Your notice must identify the issues you are appealing.
- Your appeal must be sent to:
Appeals Division
Department of Medical Assistance Services
600 East Broad Street, 6th Floor
Richmond, Virginia 23219
Second Level of Appeal (Formal)
- If you wish to appeal an Informal Appeal Decision, you must file your written notice of formal appeal with the DMAS Appeals Division within 30 days of the date of the informal appeal decision.
- Your notice is considered filed when it is date stamped by the DMAS Appeals Division.
- Your notice must identify the issues you are appealing.
- Your appeal must be sent to:
John A. Stanwix, Jr., Division Director
Appeals Division
Department of Medical Assistance Services
600 East Broad Street, 6th Floor Richmond, Virginia 23219 - The normal business hours of DMAS are from 8:00 am through 5:00 pm on dates when DMAS is open for business. Documents received after 5:00 pm on the deadline date shall be untimely. Strict timelines govern the timeliness of appeal requests and document submissions. Please refer to the Department’s Regulations governing the filing of appeals in the Virginia Administrative Code 12 VAC 30-20-500 through 570.
- For further information regarding Medicaid policy or guidelines, you may access the DMAS website at www.dmas.virginia.gov.
Contact Information for Questions on Appeals and Scheduling
For questions regarding appeals
Scott Wells, CPA, CFE
Ryan Rios, CFE
Jill Tyler, LCSW
For questions regarding scheduling
Jazzmi Green
DMAS contact information
Dacia Henry
External Providers Audit Specialist and Contract Administrator
External Provider Audit and Policy Unity
Department of Medical Assistance Services
Dacia.Henry@dmas.virginia.gov