PA CONTRACTOR
The Department of Medical Assistance Services (DMAS) is pleased to announce the award of a new Prior Authorization contract to KePRO, an innovative healthcare management solution company. KePRO will conduct the prior authorization process for Medicaid, Family Access to Medical Insurance Security (FAMIS) and FAMIS Plus clients in the fee-for-service programs. This is currently being performed by WVMI and DMAS.
Providers will immediately notice improvements to the prior authorization process such as:
• An internet accessible, web-based prior authorization interactive request and response function;
• A primarily paperless process for faster service and reduced provider administrative burden; and
• Utilization of InterQual criteria when appropriate.Prior authorization functions will be phased in through May and June 2006 as follows:
• Phase I will be implemented in May 2006 and include outpatient psychiatric services;
• Phase II will be implemented June 1, 2006 and include the traditional services of inpatient review, outpatient review (excluding outpatient psychiatric services), and EPSDT;
• Phase III will be implemented in mid June 2006 and include the Medicaid specific services of specialized behavioral health, community based care.
Effective May 22, 2006, KePRO will handle the prior authorization functions for Outpatient Psychiatric Services formerly performed by DMAS. DMAS will continue to process all pre-authorizations, appeals, and pended cases with date of receipt up to and including, May 21, 2006.
DMAS will be issuing additional information to provider and enrollees in various mailings and educational presentations in April and May 2006. Site training and web based training will be available statewide in April and May 2006.
Providers will be required to register with KePRO in order access the web technology. The form and process will be available by April 1st.
Further information regarding the new PA program will be available on the Department of Medical Assistance Service’s website at www.dmas.virginia.gov and the KePRO website at http://www.kepro.org as it becomes available.
Thank you for your assistance as we move forward to improve the quality and efficiency of our prior authorization process. Should you have any questions regarding the prior authorization program, please send your inquiries via e-mail to PAUR06@dmas.virginia.gov.
KePRO WEB BASED APLLICATION iEXCHANGE
KePRO will be utilizing a web based application called iEXCHANGE to facilitate the submission of prior authorization requests from providers. This is a user friendly system that will enable providers to submit requests 24 hours a day, seven days a week via the Internet. iEXCHANGE will streamline the prior authorization process, provide you with reporting capability and facilitate the provider workflow from prior authorization through payment.
There will be more information coming out in the weeks ahead regarding provider training which will be conducted in live sessions as well as in online sessions that will be accessible from locations with high speed Internet access. Training will include assisting providers in securing passwords, system login, account maintenance, customizing your environment and reporting capabilities. A Virginia KePRO web site is being developed and KePRO will have telephonic support available once the formal registration process begins.
Initial Frequently Asked Questions regarding iEXCHANGE:
What is required to connect to the iEXCHANGE system?
he only system requirement for hospitals or providers to enter authorization
requests is a workstation with Internet access. High speed access is recommended
to fully access the system’s capabilities. iEXCHANGE is browser based and
requires either Internet Explorer version 5.5 or higher, or Netscape Navigator
Version 4.08 or higher, with the exception of version 6.0. The browser must
allow 128-bit encryption. JavaScript must also be enabled. If a non-compliant
browser is detected, iEXCHANGE will generate an error message with links to
download compliant browsers or detailed instructions on how to enable
JavaScript.
We have users with AOL accounts. Will they be able to access
the system?
AOL uses a unique and proprietary browser. It is not supported and not
recommended for use with the iEXCHANGE system. An AOL account may be utilized
for connection to the Internet, provided a compliant browser is then launched
and used for accessing iEXCHANGE.
Is access to the system password protected? How will users be
set up?
Access to the system beyond the opening page is password protected. Each
Provider will be assigned an administrative account and password. Each Provider
will be expected to add and maintain its own user accounts in accordance with
its own security policies and procedures. It is highly recommended that
administrators should not create “generic” accounts for use by multiple
individuals. Passwords are changeable by the user.
How many accounts can be set up?
There is no limit to the number of accounts that may be set up for iEXCHANGE
access. Each Provider must maintain its accounts in accordance with its own
policies and procedures.
While online submission is strongly encouraged, KePRO will
accept FAX, telephone and mail requests as well.