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  • 445 Main Street, 2nd Floor, #1, Saco, ME 04072
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Shoreline Healthcare Technologies is a proud Maine-based company that offers end to end revenue cycle management services to physicians and Medical billing companies  in Virginia. Our goal is to help them manage their business in a way where they can focus on patient care and operations, not paperwork! By providing great services at reduced costs, we have been able to keep our customers since our inception in 2015. Explore our case studies to see how we’ve helped practices overcome complex billing challenges and improve cash flow.

As a medical billing outsourcing company, we have helped our clients grow their business by providing them with the resources they need to succeed while maintaining a competitive edge in today’s industry. We offer timesaving, cost-effective revenue cycle management services to your Virginia-based practice. Ready to outsource your billing needs? We’ll guide you through your receivable account to make sure that your claims are paid.

Best In the Industry

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Shoreline Healthcare Technologies in Virginia exceeds customer expectations and we are proud of our history, but more importantly we are focused on the future. We have grown in recent years by continuing to invest in technology and people while maintaining a commitment to excellent service and innovation. We have the best customer service and one of the highest success rates for reimbursement, so you know your money will be going where it belongs - back into your pocket.

Virginia Billing Challenges we solve



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Managing the Dual Claims Ecosystem FFS vs. Managed Care Fragmentation


The Medicaid in Virginia operates through a hybrid billing structure where providers must simultaneously manage the Fee-for-Service (FFS) claims and the multiple Managed Care Organizations (MCOs) under CCC Plus and Medallion programs. Each pathway has different claim formats, payer rules, appeal workflows, and remittance logic. Providers frequently submit technically correct claims that are denied simply because they would have followed the wrong billing pathway for a specific eligibility segment. At Shoreline Healthcare Technologies we eliminate the occurrence of misrouted claims by verifying eligibility by the program type, not just by date, we identify whether the claims must go to DMAS FFS or the correct MCO and prevents the denials caused by billing under the wrong Virginia Medicaid pathway.

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Enrollment, Revalidation & Change Management


Changes in ownership, practice address, taxonomy and rendering provider status can silently suspend the claim payments and disrupt the cash flow until enrollment records are updated with both DMAS and each individual MCO. At Shoreline Healthcare Technologies we proactively manage the provider enrollment updates with DMAS and MCOs, revalidations and demographic changes and prevents the silent payment suspensions caused by enrollment mismatches so organizations can have continuous cash flow without any unexpected payment freezes.

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Payer-Specific Timely Filing Management


Virginia does not operate under a single timely filing rule. Each payer enforces different submission and reconsideration deadlines. Claims denied once may be permanently lost if resubmitted under the wrong appeal window. Shoreline Healthcare Technologies maintains a separate filing and appeal timelines for FFS, Medallion, and CCC Plus. We have automated work queues prioritized by deadline risk with aggressive follow-up before the appeal windows close. This prevents the permanent revenue loss due to missed deadlines.

We at Shoreline Healthcare Technologies provide personalized support tailored to the unique needs of Virginia providers. Our team of experts understands the intricacies of the Virginia billing landscape and offers guidance to help practices navigate these challenges effectively with our cloud-based RCM solutions for an optimized Revenue Cycle Management.

Comprehensive Medical Billing Services for Virginia

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Specialized Services tailored to meet Virginia Medicaid rules and regulations

🩺 Services 📍Virginia Specialization 📈 Typical Improvement ⏱️ Turnaround Time
End-to-End Medical Billing Expertise across Virginia Medicaid FFS, all major Managed Care Plans (MCPs), CCC Plus and Medallion 4.0 billing workflows. 25–40% reduction in denial rates with faster reimbursement cycles. Claims submitted within 24–48 hours
Medicaid Eligibility & Program Verification Program-level verification for FFS, Medallion, and CCC Plus with proactive retroactive eligibility tracking 10–20% improvement in clean-claim rate Instant/ Within 24 hours
Charge Capture & Coding Review Virginia-specific CPT/HCPCS validation, modifier sequencing, and place-of-service accuracy 40–60% reduction in PA-related denials 24–48 hours
Provider Enrollment & Revalidation DMAS enrollment, MCO credentialing, revalidation monitoring Eliminates enrollment related denials. 3-4 weeks
CCC Plus & LTSS Billing Management Alignment of EVV data, authorizations, care plans, and unit thresholds 20–30% reduction in LTSS denials 48–72 hours
Denial Management AI based tools to track and flag denial codes and root-cause analysis tailored for Medicaid claim categories, identifies high-risk categories and automate resubmissions. Reduce rate of denial by 75% and with quicker appeals. 7–14 days for backlog cleanup; ongoing daily follow-up
Patient Statements & Follow-Up Communicate with patients and give Explanation of Benefits (EOBs). Includes text/email payment reminders and online payment options. Reduces overdue balances and increases the collection rates. 1-2 weeks
Audit & Compliance Support Conducts Audit Review and mock audits, including documentation, encounter verification, and claim reconciliation. Minimizes risk of penalties and supports successful audits. Ongoing, depending on audit schedule

Medical Billing Resources for Virginia

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Comprehensive resources specifically designed for Medicaid Providers to navigate the state’s complex Billing Landscape.

Medicaid Billing Guide

A Complete guide covering all billing requirements, policy updates and compliance standards.

Behavioral & Mental Health Billing rules and guidelines

Specialized billing guidelines and documentation procedures for behavioral health programs.

Revenue Cycle Optimization

Best Practices and Strategies to improve cash flow and reduce denials.

Telehealth and Remote patient Monitoring in Virginia

Virginia’s telehealth and RPM guidelines and regulations.

Serving Healthcare Providers Across Virginia

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From Arlington to York, we provide comprehensive medical billing services across all 133 Virginia Counties & Independent Cities.

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Northern Virginia:

Arlington, Fairfax, Fauquier, Loudoun, Prince William, Stafford.

Alexandria, Fairfax, Falls Church, Manassas, Manassas Park.

Central Virginia:

Albemarle, Amelia, Amherst, Appomattox, Bedford, Buckingham, Campbell, Caroline, Chesterfield, Cumberland, Fluvanna, Goochland, Greene, Hanover, Henrico, Louisa, Madison, Nelson, Orange, Powhatan, Prince Edward, Spotsylvania.

Charlottesville, Colonial Heights, Fredericksburg, Hopewell, Lynchburg, Petersburg, Richmond (Capital).

Coastal Virginia:

Accomack, Charles City, Essex, Gloucester, Isle of Wight, James City, King and Queen, King George, King William, Lancaster, Mathews, Middlesex, New Kent, Northampton, Northumberland, Richmond (County), Southampton, Surry, Sussex, Westmoreland, York.

Chesapeake, Franklin, Hampton, Newport News, Norfolk, Poquoson, Portsmouth, Suffolk, Virginia Beach, Williamsburg.

Shenandoah Valley:

Alleghany, Augusta, Bath, Botetourt, Clarke, Craig, Frederick, Highland, Page, Rockbridge, Rockingham, Shenandoah, Warren.

Buena Vista, Covington, Harrisonburg, Lexington, Salem, Staunton, Waynesboro, Winchester.

Southwest Virginia:

Bland, Buchanan, Carroll, Dickenson, Floyd, Franklin (County), Giles, Grayson, Henry, Lee, Montgomery, Patrick, Pulaski, Russell, Scott, Smyth, Tazewell, Washington, Wise, Wythe.

Bristol, Danville, Galax, Martinsville, Norton, Radford, Roanoke.

Southside Virginia:

Brunswick, Charlotte, Dinwiddie, Greensville, Halifax, Lunenburg, Mecklenburg, Nottoway, Pittsylvania.

Emporia. (Note: Danville is often considered the "hub" of Southside, though it is also listed with the Southwest.)

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Primary Care
Specialty Clinic
Rural Health
Mental Health
Cardiology
Dermatology
Emergency Medicine
Family Medicine
Internal Medicine
Neurology
Oncology
Orthopedics
Pediatrics
Psychiatry
Radiology
Surgery
Urgent Care
Women's Health

Frequently Asked Questions

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FAQs about Medical Billing Services in Virginia

Q1. Why is it critical to bill the CCC Plus claims correctly?

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CCC Plus plans covers the high-cost LTSS and HCBS services, where denials are often non-recoverable. Payment depends on the exact alignment of authorizations, EVV data, care plans, and billed units. Even small errors can trigger permanent revenue loss or post-payment recoupments, making precision essential for cash-flow stability.

Q2. What is Medicall System and why do providers need it?

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The MediCall System is the state’s automated eligibility verification system. Providers use MediCall to confirm the patient’s Medicaid status, program enrollment (such as FFS, Medallion, or CCC Plus), and coverage dates. It also helps to check whether the claims are billed to the correct payer and program and the Remittance advice.

Q3. 25. Does Shoreline help with audits and recoupments?

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Yes. Shoreline prepares audit-ready claims with supporting documentation alignment; we also help providers respond to the post-payment reviews and recoupments.

Q4. What are the initial processes that Shoreline does on onboarding?

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  • ➣ Reviews current billing workflows and denial patterns
  • ➣ Confirms Virginia Medicaid and MCO enrollment status
  • ➣ Sets up payer-specific claim rules, timely filing limits and authorization workflows
  • ➣ Transits claims without disrupting the cash flow

Providers can see an increase in clean claim submission within the first few weeks of onboarding, with measurable performance improvements by partnering with Shoreline Healthcare Technologies.

Q5. What are the factors that influences the process of onboarding?

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  • ➣ Active status of the provider with Virginia Medicaid and other MCOs
  • ➣ Data access (EHR, clearinghouse, payer portals)
  • ➣ Volume of legacy A/R and denied claims
  • ➣ Scope of services (full RCM vs. partial support)

Q6. How can Shoreline Healthcare Technologies help providers in Virginia?

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We at Shoreline Healthcare Technologies handle the entire process of RCM Cycle from patient appointment scheduling to eligibility checks, prior auths, coding, claim submissions, denials, and appeals, till payment processing and patient communication ensuring faster payments and compliance with state specific rules. We also offer analytics and process automation to reduce first pass rejects in state systems and to reconcile managed-care encounter reporting.

Compliance & Certifications

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Your data security and compliance are our top priorities.

HIPAA Compliant

Full HIPAA compliance with regular audits

AAPC Certified

Certified Professional Billing Staffs.

Virginia Licensed

Licensed to operate in Virginia

Medical Billing Glossary

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Essential Terms for Understanding the Virginia’s Medical Billing Landscape

Cardinal Care

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The unified Medicaid program structure of Virginia that integrates multiple coverage pathways including the managed care and long-term services under a single brand. It was designed to simplify member access while standardizing provider participation, though the billing rules still vary by program type and MCO.

Commonwealth Coordinated Care Plus (CCC Plus)

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The managed care program that combines acute care, behavioral health, and LTSS under one coordinated model.

Department of Medical Assistances Services (DMAS)

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The agency for administering the Medicaid and FAMIS programs for the state of Virginia. It manages the provider enrollment, policy development, fee-for-service claims, managed care contracts, audits, and compliance for the state.

Family Access to Medical Insurance Security (FAMIS)

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It is Virginia’s public health coverage program for children and teens whose families earn too much to qualify for traditional Medicaid but cannot afford private insurance. It operates under the broader Cardinal Care umbrella and is administered by DMAS through managed care plans

Medallion 4.0

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The primary managed care program for children, pregnant women, and adults without long-term care needs. Services are delivered through contracted MCOs, each have their own billing rules, timely filing limits, and denial logic requiring payer-specific billing workflows.

Provider Services Solution (PRSS) module

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The Medicaid Enterprise System used by providers to manage enrollment data, submit updates, and maintain compliance records.

Our Services

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Shoreline proudly supports physicians, medical groups, and medical billing companies. Following are the revenue cycle management steps we offer.

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Testimonials

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We Care

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From electronic health records, billing services and practice management tools-Shoreline has you covered! In addition to being industry leader when it comes to pricing, we also provide personalized support for every client, with a team of experts who have worked with physicians and medical groups for years, Shoreline Healthcare Technologies in Virginia understands how to navigate today’s complex healthcare revenue environment.

Ready to Optimize Your Medical Billing?

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Get your free consultation and discover how much you could save with our Virginia-specialized billing services.

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Contact Information

  • 445 Main Street, 2nd Floor, #1, Saco, ME 04072
  • 1-855-838-1370
  • info@shorelinemb.com
  • M-F, 9am - 5pm EST

Why work with us?
  • 40% average denial rate reduction
  • Local billing expertise
  • 24-48 hour claim turnaround
  • Dedicated Virginia support team