Credentialing by state / Virginia
Nurse Practitioner Credentialing in Virginia
Enrollments are billed 50% at the start and 50% at submission; everything else 100% at the start.
| NP practice environment | Restricted Practice (AANP) |
|---|---|
| Licensing authority | The Virginia board of nursing, with physician collaboration or supervision required |
| Medicare contractor | Palmetto GBA, jurisdiction JM |
| Medicaid | Virginia Medicaid (Cardinal Care), enrolled through the Provider Services Solution (PRSS) portal |
| Medicaid managed care | 5 plans, 1,810,041 members (2024) |
| Blue Cross Blue Shield plan | Anthem Blue Cross and Blue Shield |
Virginia Is a Restricted Practice State
The American Association of Nurse Practitioners classifies Virginia as restricted practice: state law requires career-long supervision, delegation or team management by another health provider for the NP to provide patient care. 11 of the 50 states and DC have that classification, and they are where NP applications most often stall on agreement paperwork.
For credentialing, restricted practice means the supervising physician is effectively part of your application. Virginia Medicaid (Cardinal Care) and the commercial plans, including Anthem Blue Cross and Blue Shield, typically ask for the supervision or delegation agreement, the physician's name, NPI and license, and sometimes the physician's own attestation. Some plans in restricted states credential NPs only as members of a physician-led group, so an NP-owned entity may be told the panel is limited even when the application is complete.
Medicare enrolls the NP on the CMS-855I without asking for the agreement, but its NP rule (42 CFR 410.75) requires compliance with Virginia law, so supervision has to be in place before you bill Palmetto GBA. When the supervising physician leaves, the NP's ability to practice and to be paid depends on a new agreement being signed and reported to every plan, which makes that change the single biggest credentialing risk for a Virginia NP.
Virginia Medicaid (Cardinal Care) Managed-Care Plans for NPs
After the state enrollment, each managed-care plan credentials you as its own application. The largest in Virginia by 2024 enrollment:
- Sentara Health Plans: 624,067 members
- Anthem Healthkeepers: 543,748 members, owned by Elevance Health
- Aetna Better Health of Virginia: 271,844 members, owned by CVS Health
See all 5 plans.
Neighboring States
If you practice near the border or by telehealth, the rules change at the state line: Washington, DC is full practice, Kentucky is reduced practice, Maryland is full practice, West Virginia is reduced practice. North Carolina, Tennessee share Virginia's classification.
- Washington, DC NP credentialing (Full Practice)
- Kentucky NP credentialing (Reduced Practice)
- Maryland NP credentialing (Full Practice)
- North Carolina NP credentialing (Restricted Practice)
- Tennessee NP credentialing (Restricted Practice)
- West Virginia NP credentialing (Reduced Practice)
The full NP checklist, the entity decision and where applications stall are in our nurse practitioner credentialing guide. For Medicare, Medicaid and commercial plans for every clinician type in the state, see credentialing in Virginia.
Questions Virginia NPs Ask
Do Virginia nurse practitioners need a collaborating physician to get credentialed?
Yes in practice. AANP classifies Virginia as restricted practice, and Virginia Medicaid (Cardinal Care) and most commercial plans ask for the supervision or delegation agreement and the physician's name and NPI with the application.
How does a Virginia NP join Virginia Medicaid (Cardinal Care)?
Enroll with the Virginia Department of Medical Assistance Services through the Provider Services Solution (PRSS) portal. Most Virginia Medicaid (Cardinal Care) members are in managed care (1,810,041 enrolled across 5 plans in 2024), so after the state enrollment is active, each plan you want, such as Sentara Health Plans, Anthem Healthkeepers, Aetna Better Health of Virginia, credentials you separately.
Can an NP licensed in Virginia see patients in a neighboring state?
Only with a license from that state, and each state's practice rules apply to the patients there. Washington, DC is full practice; Kentucky is reduced practice; Maryland is full practice; North Carolina is restricted practice; Tennessee is restricted practice; West Virginia is reduced practice. Payer enrollment is also per state, so seeing patients across the line means a separate Medicaid enrollment and separate commercial applications there.
What does PECS charge a Virginia NP?
CAQH (DataSpring) profile build $500; Medicare enrollment $500; Virginia Medicaid (Cardinal Care) enrollment $500; each commercial application, including Anthem Blue Cross and Blue Shield, $200 per provider. Enrollment services bill 50% at engagement and 50% at submission.
Answers cover PECS services, prices and process. For legal, tax or clinical questions please consult a professional.
Sources: American Association of Nurse Practitioners, State Practice Environment (updated May 2026); KFF, Medicaid MCO Enrollment by Plan and Parent Firm, 2024. Practice classification is AANP's; confirm current rules with the Virginia board of nursing. Updated October 7, 2026.