Credentialing in Vermont

Vermont Medicaid is administered by DVHA, with provider enrollment, forms and claims running through vtmedicaid.com, operated by Gainwell Technologies as fiscal agent. Forms currency is enforced, information submitted on outdated forms is returned unprocessed, so pull current forms per submission.

vtmedicaid.com (Gainwell) via kb/states/vt.md · checked Jul 2026

Vermont runs essentially its entire Medicaid program under the Global Commitment to Health Section 1115(a) waiver, with the state itself playing the managed-care role: DVHA carries the MCO-style network obligations directly (e.g. an adult PCP-to-enrollee ratio of 1:1,000 binds DVHA, not any plan). There are NO commercial Medicaid MCOs. One enrollment with Vermont Medicaid IS network participation, with no plan-by-plan contracting layer. The structure is locked through at least end-2027; CMS denied Vermont's request to convert DVHA into a risk-bearing MCO.

VT AHS Global Commitment to Health waiver page via kb/states/vt.md · checked Jul 2026

18 V.S.A. § 9408a requires an insurer to act upon and FINISH the credentialing process within 60 calendar days of receiving a completed application, with deficiency notices due within 30 business days. And it statutorily mandates the CAQH application as Vermont's uniform credentialing form. Use it on Vermont's commercial payers (BCBSVT, MVP); DVHA/Medicaid is not an 'insurer' under this chapter.

18 V.S.A. § 9408a (official statute text) via kb/states/vt.md · checked Jul 2026

Vermont's supervised-billing rule (HCAR 9.103) lets a supervisee accruing hours toward licensure provide clinical services billed to Vermont Medicaid under the clinical supervisor's license, with the HM modifier on claims. The 2026 twist: all supervisees must now themselves enroll with Vermont Medicaid (enrollment opened 10/1/2025, mandatory for billing 1/1/2026). Qualified supervisors, psychiatrist, psychiatric NP, clinical psychologist, LMFT, LCMHC, clinical social worker, or drug/alcohol counselor, must be VT-Medicaid-enrolled with 15-minute availability. A supervisee who is eligible for licensure but not licensed is NOT covered. One of the cleanest associate lanes in the country.

HCAR 9.103 Supervised Billing adopted rule via kb/states/vt.md · checked Jul 2026

Vermont enacted the Counseling Compact in 2023 (Act 34, effective July 1, 2024) and appears on the compact's jurisdictions list, but is not yet issuing or receiving privileges. Issuers as of July 2026 are only AZ, MN, OH, LA, GA and IN.

counselingcompact.gov jurisdictions via kb/states/vt.md · checked Jul 2026

Vermont's commercial market is a two-payer state: BCBSVT (EPO) and MVP Health Care (HMO) are the entire exchange/commercial list, a VT roster without MVP is missing half the market. For plan-year 2026, Vermont Blue Advantage and UnitedHealthcare both exited Medicare Advantage, leaving Humana as the only individual MA option, in just six counties (Bennington, Caledonia, Essex, Orange, Windham, Windsor). The Cigna/HealthSpring listing is a closed retired-teachers group contract, not joinable.

VT 2026 payer landscape (web-verified 2026-07-10) via kb/states/vt.md · checked Jul 2026