Prior Authorization
Starting January 1, 2007, timely submission for prior authorization (PA)
requests through KePRO will be reinstated and determinations will be based on
timeliness.
Questions : Contact KePRO at 888.827.2884 or via email at
ProviderIssues@kepro.org or
PAUR06@dmas.virginia.gov
The Department of Medical Assistance Services contracts with Keystone Peer
Review Organization (KePRO) to handle the prior authorization (PA) process for
Medicaid, Family Access to Medical Insurance Security (FAMIS) and FAMIS Plus
clients in the fee-for-service programs. The KePRO PA contract excludes:
1) Services managed under a separate contract, including pharmacy, dental,
transportation, Mental Retardation &
Day Support Waivers, and managed care
organization (MCO) vendor services;
2) Authorizations maintained by DMAS Medical Support (Organ Transplants, Gastric
Bypass, Cosmetic
Procedures, Prostheses); and,
3)
Certain waiver enrollment/service authorizations
maintained by DMAS Long-Term Care.
KePRO accepts PA requests via iEXCHANGE® (an interactive web-based application), telephone, paper, and fax submission. For most services the preferred method of submission is iEXCHANGE®. Registration is required and once completed, providers can expect to receive their iEXCHANGE user login and password by email within 10 business days.
|
Prior Authorization Request Submission Options |
|
| Internet / iEXCHANGE® | Telephone 1-888-VAPAUTH (827-2884) 804-622-8900 (local) |
| Fax 1-877-OKBYFAX (652-9329) |
U.S. Mail KePRO 2810 North Parham Road, Suite 305 Richmond, VA 23294 |
Questions regarding the prior authorization process can be sent via e-mail to providerissues@kepro.org or PAUR06@dmas.virginia.gov .
*** Note: Do not send PHI by email unless it is sent via a secure encrypted email transmission.
Provider Training Presentations
- Medicaid Memos to Providers
- FAQs - Updated May 4, 2006 (pdf)
- FAQs - Updated June 1, 2006 (pdf)
- Prior Authorization Fax Forms
Inpatient Prior Authorization Request - DMAS-362 (editable, dot)
Outpatient Prior Authorization Request - DMAS-363 (editable, dot)
Substance Abuse Services Prior Authorization Request Form DMAS-363-A
Substance Abuse Services Prior Authorization Request Form DMAS-363-A (editable, doc)
Treatment Foster Care Prior Authorization Request Form DMAS-364
Treatment Foster Care Prior Authorization Request Form DMAS-364 (editable, dot)
Community Based Care Waiver Request - DMAS-98 (editable, dot)
Residential Treatment Care Prior Authorization Request Editable Form (editable, dot)
IIH Prior Authorization Request Editable Form - DMAS-366 (editable, dot)
- Prior Authorization Reference Guides
- Codes