Verified October 10, 2026 against the statutes, regulations and sources cited below. General information, not legal advice. All states
What providers miss in Virginia
- The any willing provider statute says the State Corporation Commission has no jurisdiction to adjudicate controversies arising under it, so enforcement is not through an SCC complaint.
- The 60-day clock and pending-period pay apply only when the carrier already contracts with the applicant or the applicant's practice.
- A plan may not refuse to credential a provider solely because the provider treats many patients who need expensive or uncompensated care.
Does Virginia have an any willing provider law?
Insurers offering preferred provider policies must set nondiscriminatory terms, and no hospital, physician or listed provider type willing to meet those terms may be excluded. The rule covers PPO policies; price differences from individual negotiation are not unreasonable discrimination.
- Limited any willing provider law
Citation: Va. Code 38.2-3407(B)
How long can a plan take to credential a provider in Virginia?
A carrier must approve or deny within 60 days of a completed application. An application is deemed complete 30 days after receipt unless the carrier says otherwise. Without an existing contract, state rules allow up to 120 days for clean applications.
- Deadline: 60 days
- Applies to: Carriers, when the applicant or the applicant's employer already has a contract with the carrier
Citation: Va. Code 38.2-3407.10:1(B); 12 Va. Admin. Code 5-408-170(D)
Can a provider practice in network while Virginia plans credential them?
Once approved, a new applicant under an existing contract is paid at the in-network rate for covered services given while the application was pending, with claims paid within 40 days after credentialing and contracting.
Citation: Va. Code 38.2-3407.10:1(B)
What network adequacy rules apply in Virginia?
Access to care in managed care health insurance plans is assessed by the Virginia Department of Health under its managed care quality assurance law.
Citation: Va. Code 38.2-5807; 32.1-137.1 et seq.
Will the Virginia insurance department take a provider complaint?
- Virginia State Corporation Commission, Bureau of Insurance
Who oversees Medicaid managed care plans in Virginia?
- Virginia Department of Medical Assistance Services (Cardinal Care)
Turned down by a plan in Virginia?
We read the denial, check which of these rules reach that plan, and prepare the reconsideration request, the access-gap evidence and any regulator complaint the law supports; you sign and send them, and we track every deadline. Self-funded employer plans follow federal law, not Virginia's. A rejection review is $249, credited toward a dispute.