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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.
 

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.
 

• New Prior Authorization Contractor
  

• iExchange^® Registration

• Provider Training Presentations

  • DMAS and KePRO Your Key to PA  

  • Overview of New Prior Authorization Program for June 2006 (ppt)

  • Provider Training Presentation for April 2006 (ppt)
     

• 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 (pdf)

• Inpatient Prior Authorization Request - DMAS-362 (editable, dot)

• Outpatient Prior Authorization Request - DMAS-363 (pdf)

• 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 (pdf)

• Community Based Care Waiver Request - DMAS-98 (editable, dot)

• Residential Treatment Care Prior Authorization Request Editable Form (editable, dot)

• IIH Prior Authorization Request Form - DMAS-366
  

• IIH Prior Authorization Request Editable Form - DMAS-366 (editable, dot)
   

• Prior Authorization  Reference Guides

• Codes

  • ICD9 Diagnosis Codes

  • Revenue Codes for Home Health and Out Patient Rehab Services

  • CPT Codes For Radiological Scans