The VillageCareMAX Provider Portal represents a comprehensive digital platform designed to streamline healthcare provider interactions, offering efficient tools for claims management, authorization requests, and member eligibility verification. This secure online resource empowers healthcare professionals with quick and convenient access to essential administrative functions.
Official Links
- Provider Portal: https://www.villagecaremax.org/provider-portal
- Providers Page: https://www.villagecaremax.org/providers
What Providers Can Do
The VillageCareMAX Provider Portal offers multiple critical functionalities for healthcare professionals:
Claims and Eligibility Portal
- Verify member eligibility
- Review claims status
- Submit claims inquiry requests
- Available 24/7
Authorization Portal
- Electronically submit authorization requests
- Navigate through care management criteria
- Receive automated responses
- Get real-time updates
- Check authorization statuses
- Add supporting documentation
- Update discharge information
- Submit authorization appeals
Portal Access Requirements
Registration Criteria
- Must be an in-network provider
- Requires a valid National Provider Identifier (NPI) number
Key Features
Comprehensive Provider Support
- Maintains current referral patterns
- Provides care management team assistance
- Offers around-the-clock nurse coordinator access
Integrated Care Coordination
- Supports Patient-Centered Medical Home initiative
- Collaborates with community services
- Coordinates medical, behavioral, and pharmaceutical services
Privacy and Compliance
Required Provider Responsibilities
- Monthly check of governmental exclusion lists
- Verify no staff are excluded from government programs
- Complete mandatory training programs
Training Requirements
-
Culturally and Linguistically Appropriate Services (CLAS) Training
- Required by VillageCareMAX and Office for Minority Health
- Covers 15 National CLAS Standards
- Attestation deadline: September 30, 2025
-
Special Needs Plans (SNP) Model of Care Training
- Required by Centers for Medicare & Medicaid Services (CMS)
- Focuses on unique enrollee needs
- Attestation deadline: September 30, 2025
Technical Support
Provider Services Contact
- Phone: 1(855)769-2500
- Provider Inquiry Form available on website
- Supports claims, authorizations, network inquiries
System Updates
2025 Changes
Effective January 1st, 2025, VillageCareMAX will:
- Change partner for plan administration functions
- Potentially modify provider interaction processes
Additional Resources
Helpful Documentation
- Provider Portal Quick Reference Guide
- Provider Portal Authorizations User Guide
- 2025 Provider Education Webinar
- Quarterly Provider Bulletins
Compliance and Legal
Important Notes
- Non-participating providers must submit a signed Waiver of Liability form for claim appeals
- Adherence to privacy and compliance policies mandatory
The VillageCareMAX Provider Portal offers a robust, secure platform designed to simplify healthcare provider administrative tasks, enhance care coordination, and support efficient patient management.
Unprovided Information
- Specific login procedure details
- Exact portal interface screenshots
- Detailed technical requirements for portal access
Contact Information
- Provider Services: 1(855)769-2500
- General Inquiries: 1(800)469-6292
Last Updated: 08/12/2025
FAQ
What type of insurance is VillageCareMAX?VillageCareMAX is a Medicaid Managed Long-Term Care (MLTC) Plan that was created to help you to continue to stay at home, and in your community, for as long as possible.
How much does VillageCareMAX pay?Salaries at VillageCareMAX typically range from $104,199 to $134,096 annually, reflecting the diverse roles and experience levels within the company.
How does VillageCareMAX collect continuous feedback on members’ experience with the plan?Members are assessed on an ongoing basis in their homes or by phone by their dedicated Care Manager.
Who is the CEO of VillageCareMAX?We are coming together as two well-respected, community-based health care organizations that are driven by individuals’ needs, and we’re building on that,” said Emma DeVito, President and CEO of VillageCare.
https://www.villagecaremax.org/provider-portal
Enter Portal HERE. Including member eligibility for 2025 Dates of Service, and submit claims or review status for claims with 2025 Dates of Service. For
https://www.villagecaremax.org/providers
This portal is a quick, convenient, and secure way to verify member eligibility, review claims status, submit claims inquiry request and much more.