Virginia Birth Injury Program Portal

Program Portal

Complete the form below to receive information, get questions answered, learn more about claim reimbursements and Program benefits, or submit general inquiries.
Instructions: Go to the text boxes and dropdown options below to make your selection. The above progress bar will provide a status for completion of the submission.

--> Want to file a claim? Complete this Form, Select Inquiry Type and select Claim Reimbursement Form (2024 or 2025) and hit Submit. You will be redirected to the Claim Reimbursement Form.

--> Want to get the list of documentation required? Complete this Form, Select Inquiry Type and select the type of claim and hit Submit. You will be redirected to that claim process and documentation requirements.
1. Your First Name and Last Name*

First NameLast Name
2. Admitted Claimant First Name and Last Name*
Bill Smith (or if a general request type N/A)
3. Program Affiliation*
Agency Name
If Agency is selected, click Submit below to be redirected to the appropriate form.
If Caregiver (Family or Independent) is selected, click Submit below to be redirected to the appropriate form.
4. Request Type or CLAIM Type (please select one option)*
If you have multiple inquiries, you will have another opportunity to submit requests at the end of this form.
4a. Agency/Facility or Caregiver Name (if applicable)
Agency ABC
4b. Vendor Name (if applicable)
ABC Vendor/Consultant
5. Phone Number*
6. E-mail Address*
example@example.com
7. Is your inquiry regarding a claim reimbursement processed by the Program's third-party administrator, Benefit Plan Administrators (BPA)? If so, then check the appropriate box below. (Optional)

Yes, this inquiry is regarding a claim reimbursement submitted to Benefit Plan Administrators (BPA) before the November 2024 Program correspondence.No
8. What support are you requesting? Explain below. Message or Detailed Questions or write N/A if no questions/comments. (Optional)*

Example: I have a question about a claim to file or xyz benefit.0/160
Looking to submit Caregiver Timesheets and the Monthly Care Summary? Click these shortcut links below.

Click this LINK --> Caregiver Timesheets (Or See the Form below)
Click this LINK --> Monthly Care Summary
Click this LINK --> Program's Claim Reimbursement Form
9. Please upload in the link below any additional documentation to expedite your request for review. (Optional)

Format: PDF (desktop or mobile uploads), Word, JPG or PNG (scanned, digital images, etc.)
Cancelof
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