Cardinal Care MCO Payer IDs for Virginia Therapy Claims

As of October 9, 2026.

There is no single Cardinal Care payer ID for every Virginia Medicaid therapy claim. First identify the member’s coverage for the date of service using Virginia Medicaid eligibility verification, then match the assigned plan and claim type to the clearinghouse destination.

As of October 9, 2026, DMAS lists Aetna, Anthem, Humana, Sentara and UnitedHealthcare as the five Cardinal Care MCOs. Humana replaced Molina effective July 1, 2025. Cardinal Care also includes FFS members. Official DMAS plan list.

Current Cardinal Care MCO Claims Payer IDs

The table records the IDs in each plan’s public claims guidance, checked October 9, 2026. Use it as a starting reference for claims transactions, then confirm the clearinghouse entry for the member’s product and behavioral health service.

Sentara’s manual is linked from its official provider-manual hub and is effective October 1, 2026. Anthem’s manual specifically tells providers using a clearinghouse or billing vendor to confirm the payer ID with that vendor. Anthem EDI instructions.

Humana’s “Fee-for-Service Claims” Wording

The Humana Virginia claims page uses “fee-for-service claims” when listing 61101 for claims submitted to Humana. That wording does not direct DMAS FFS members to Humana. If eligibility shows state FFS coverage, use DMAS FFS claims guidance and the existing FFS vs MCO routing guide.

Behavioral Health Routing Needs a Separate Check

• UHC/Optum: use Virginia Provider Express resources for the behavioral health network and authorization workflow. UHC’s EDI list includes 87726 for OptumHealth Behavioral Solutions as well as Virginia Community Plan; confirm the correct product entry.

• Sentara: the plan distinguishes medical and behavioral health paper-claim destinations in its provider FAQ. A different paper address is not evidence of a different electronic payer ID.

• Aetna and Anthem: start with their Virginia Medicaid claim instructions and the member’s coverage. Do not substitute a commercial plan or another state’s behavioral health payer ID. Aetna Virginia claims; Anthem Virginia manual.

For FFS behavioral health service authorization, continue to the existing DMAS/Acentra authorization guide. A payer ID identifies a claim destination; it does not establish provider participation, eligibility, or authorization.

Before Sending a Professional Therapy Claim

1. Verify the date-of-service coverage and assigned plan; keep the result with the billing record.

2. Confirm the relevant behavioral health network, service authorization and billing/rendering provider enrollment.

3. Select the plan’s professional-claims destination in your clearinghouse. Keep member ID, provider NPI and claim payer ID in their separate fields.

4. Review clearinghouse and payer acknowledgments, then use the plan’s claim-status process. A file leaving the EHR is not proof of payer acceptance.

Aetna’s claims FAQ explains that claims rejected before reaching the plan will not appear in its online claim inquiry. Investigate the rejection before assuming the plan has denied payment.

Related Virginia Medicaid Guides

• Virginia Medicaid therapy claim routing

• PRSS enrollment vs MCO credentialing

• MES vs PRSS and plan portals

• Keep PRSS enrollment current through revalidation

Frequently Asked Questions

Is Cardinal Care one insurance payer?

No. Cardinal Care includes state FFS and managed-care members. The member’s service-date coverage determines the claim destination.

Can I use a medical payer ID for every behavioral health claim?

Confirm the member’s product, behavioral health administrator and clearinghouse transaction before submitting. The reference table does not establish a universal route for every service.

Are claims payer IDs the same as eligibility or ERA IDs?

Do not assume so. This guide concerns claims destinations; verify eligibility and remittance transaction mappings separately with the plan and clearinghouse.