Sentara Healthcare is a not-for-profit healthcare system that serves Virginia and northeastern North Carolina. The system includes 12 hospitals, including Sentara Norfolk General Hospital, Sentara Leigh Hospital, and Sentara Martha Jefferson Hospital. Sentara also operates numerous outpatient facilities, including Sentara Medical Group, Sentara CarePlex, and Sentara Hospice. The organization accepts Medicaid, a government-funded health insurance program for low-income individuals and families. This means that Sentara provides medical care to eligible Medicaid recipients at no or low cost.
Medicaid Coverage and Eligibility at Sentara Healthcare
Depending on the state you live in, Sentara Healthcare provides Medicaid coverage for those who qualify. While Medicaid eligibility and services are extensive, there may be some variations based on your location.
How to Determine Your Eligibility for Medicaid at Sentara
- Consult the Medicaid website in your state to obtain detailed information about eligibility.
- Alternatively, you can visit the Sentara Healthcare website or contact their customer service department directly for assistance with eligibility determination.
Medicaid Services Typically Covered by Sentara Healthcare
- Routine Checkups
- Emergency Medical Treatment
- Hospitalization
- Prescription Medications
- Medical Equipment
- Nursing Home Care
Medicaid Plans Offered by Sentara Healthcare: A Summary
| Plan | Benefits | Eligibility |
|---|---|---|
| Sentara Medicaid Managed Care Plan |
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| Sentara Medicaid Fee-for-Service Plan |
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For the most up-to-date information on Sentara’s Medicaid coverage and services, please visit their website or contact their customer service department.
Applying for Medicaid at Sentara
If you want to explore Medicaid coverage options at Sentara, you can follow these steps:
- Check Medicaid Eligibility: Determine if you meet the income and asset requirements for Medicaid coverage in your state. Criteria may differ across states.
- Find Application Forms: Obtain Medicaid application forms from the state’s Medicaid office or download them from the official Medicaid website.
- Complete Application: Fill out the application thoroughly and accurately, providing personal information, financial details, and any supporting documents required.
- Submit Application: Submit the completed application package to the designated state Medicaid office or mail it according to the provided instructions.
- Interview and Review: In some cases, you may need to participate in an interview or attend a review process to verify the information provided in your application.
- Decision and Approval: After evaluating your application, the state Medicaid office will notify you of the decision regarding your eligibility for coverage.
- Medicaid Card: If approved, you will receive a Medicaid card that serves as proof of your enrollment in the program.
Once you have successfully applied for Medicaid and received approval, it’s important to remember the following:
- Renew Coverage: You may need to renew your Medicaid coverage periodically to maintain your eligibility.
- Managed Care Plans: In some states, Medicaid recipients are enrolled in managed care plans. You might have options to choose from different plans.
- Changes in Circumstances: Notify the Medicaid office promptly about any changes in your personal information, income, or address to ensure continued eligibility.
- Provider Network: Check with Sentara to confirm that they participate in your state’s Medicaid program and accept your Medicaid coverage.
To locate a Sentara healthcare provider or facility that accepts Medicaid, you can use the following table:
| Facility Name | Location | Services Offered |
|---|---|---|
| Sentara CarePlex Hospital | Hampton, VA | Inpatient and outpatient care, emergency services, surgery, maternity care |
| Sentara RMH Medical Center | Harrisonburg, VA | Inpatient and outpatient care, emergency services, surgery, cancer care |
| Sentara Norfolk General Hospital | Norfolk, VA | Inpatient and outpatient care, emergency services, surgery, heart and vascular care |
| Sentara Martha Jefferson Hospital | Charlottesville, VA | Inpatient and outpatient care, emergency services, surgery, orthopedics |
| Sentara Williamsburg Regional Medical Center | Williamsburg, VA | Inpatient and outpatient care, emergency services, surgery, women’s health |
Remember, the availability of services and providers accepting Medicaid may vary depending on your location and the specific Medicaid program in your state. Contact Sentara or your state’s Medicaid office for the most up-to-date information.
Medicaid Services Covered by Sentara
Sentara is a healthcare system that provides various medical services to individuals in Virginia and North Carolina. To ensure access to quality healthcare for all, Sentara accepts Medicaid, a government-sponsored health insurance program that helps low-income individuals and families cover medical expenses. Let’s explore the Medicaid services covered by Sentara.
Covered Medical Services:
- Emergency Room Services: In emergency situations, Sentara provides necessary medical care and treatment to Medicaid recipients.
- Hospitalization: If hospitalization is required, Sentara offers inpatient care, including medical and surgical procedures, to Medicaid beneficiaries.
- Outpatient Services: Medicaid recipients can access a range of outpatient services at Sentara, including doctor’s visits, specialty care, laboratory tests, and diagnostic imaging.
- Mental Health and Substance Abuse Treatment: Sentara offers mental health and substance abuse treatment services to Medicaid beneficiaries, including counseling, therapy, and medication management.
- Preventive and Wellness Services: Routine screenings, immunizations, and health education are available to Medicaid recipients through Sentara.
- Pediatric Services: Sentara provides specialized care for children and adolescents covered by Medicaid, including pediatric clinics, developmental screenings, and immunizations.
- Home Health Services: Medicaid recipients who require skilled nursing care at home can access home health services provided by Sentara.
- Hospice Care: Sentara offers hospice care to Medicaid beneficiaries with life-limiting illnesses, providing compassionate end-of-life care.
Additional Services:
Beyond the medical services mentioned above, Sentara may offer additional services to Medicaid recipients, including:
- Transportation Assistance: Sentara may provide transportation assistance to Medicaid beneficiaries who have difficulty getting to their medical appointments.
- Case Management: Some Sentara facilities may have case managers who help Medicaid recipients coordinate their care and access necessary resources.
- Health Education and Support Groups: Sentara may offer health education programs and support groups for Medicaid beneficiaries with specific health conditions.
Medicaid Coverage Variations:
It’s important to note that Medicaid coverage may vary depending on the state and individual circumstances. To ensure accurate information about Medicaid benefits and coverage, it’s always best to contact the local Medicaid office or visit the Sentara website for more details.
| State | Medicaid Eligibility | Medicaid Coverage Details |
|---|---|---|
| Virginia | Individuals and families with low income and limited resources | Sentara accepts Medicaid and offers a range of covered medical services, including emergency room services, hospitalization, outpatient care, and mental health treatment. |
| North Carolina | Individuals and families with low income and limited resources | Sentara accepts Medicaid and provides various covered medical services, such as emergency care, inpatient and outpatient services, preventive care, and pediatric care. |
Medicaid Eligibility at Sentara
To ensure smooth processing and prompt reimbursement, providers should follow the Medicaid billing procedures outlined by Sentara.
Medicaid Billing Procedures at Sentara
- Provider Enrollment:
Ensure your practice is enrolled with Virginia Medicaid and Sentara Health Plans. - Claim Submission:
Submit claims electronically through a clearinghouse or via the Sentara Provider Portal. - Claim Format:
Claims must be submitted in the CMS-1500 or 837 electronic format. - Required Information:
Include the patient’s Medicaid ID, provider NPI, and Sentara Health Plans provider ID. - Documentation:
Maintain accurate medical records and supporting documentation. - Prior Authorization:
Obtain prior authorization for specific services as required by Sentara Health Plans.
Provider Resources
- Sentara Provider Portal: Access claim status, view remittances, and update provider information.
- Provider Education: Attend workshops and webinars to stay updated on Medicaid policies and procedures.
- Customer Service: Contact the Sentara Provider Relations team for assistance with billing questions.
Medicaid Reimbursement Rates
Medicaid reimbursement rates are determined by the Virginia Department of Medical Assistance Services (DMAS) and are subject to change. Providers should refer to the DMAS website for the most current fee schedule.
FAQs on Medicaid Billing
| Question | Answer |
|---|---|
| What is the deadline for submitting Medicaid claims? | Claims must be submitted within 12 months from the date of service. |
| How can I track the status of my Medicaid claims? | You can track claim status through the Sentara Provider Portal or by contacting the Sentara Provider Relations team. |
| What should I do if I have questions about Medicaid billing? | Contact the Sentara Provider Relations team for assistance. |
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