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Service Authorization


Overview

The Department of Medical Assistance Services contracts with Keystone Peer Review Organization (Kepro) to handle the service authorization process for Medicaid, Family Access to Medical Insurance Security (FAMIS) and FAMIS Plus clients in the fee-for-service programs. The Kepro (service authorization) contract excludes:

  1. Services managed under a separate contract, including pharmacy, dental, transportation, Behavioral Health, Intellectual Disability & Day Support Waivers, and managed care organization (MCO) vendor services;
  2. Please contact the Provider Helpline at 1-800-552-8627 (in-state long distance) or (804) 786-6273 (local and out of state customers) for services that are currently authorized by DMAS Medical Support Unit;
  3. Certain waiver enrollment/service authorizations [pdf] Maintained by DMAS Office of Community Living

Kepro accepts service authorization requests via Atrezzo Connect (an interactive web-based application), telephone, paper, and fax submission. The preferred submission method is through direct data entry (Atrezzo Connect) for a quicker response. Specific information regarding the service authorization requirements and methods of submission may be found on the contractor’s website at https://dmas.kepro.com/.


 

Request Submission Options

  1. Overview of Service Authorization Contractor [pdf] and Atrezzo Connect Web Based Application;
  2. Atrezzo Connect - Log In;
  3. U.S. Mail - Kepro 2810 North Parham Road, Suite 305 Richmond, VA 23294;
  4. Telephone - 1-888-VAPAUTH (827-2884) 804-622-8900 (local);
  5. Fax - 1-877-OKBYFAX (652-9329)
  6. Expansion requests: https://dmas.kepro.com/
Notice to Providers Regarding DMAS Policy Change and New Forms for Personal/Attendant Care and Supervision Requests

Effective May 1, 2019, DMAS has a new Policy change for children in the Commonwealth Coordinated Care Plus waiver. For children under the age of 21 who are currently enrolled in, or those seeking new enrollment in to the CCCP Waiver, their personal care and attendant care needs are to be reviewed under the CCCP Waiver benefit, rather than EPSDT. Providers are to submit the personal and attendant care requests to Kepro via the CCCP waiver service types, 0900 (EDCD) or 0960 (Tech Waiver) utilizing CCCP Waiver rules and forms. For children who do not have a new or existing waiver enrollment, these services must be submitted under the EPSDT service type 0091, utilizing the EPSDT rules and forms. Additionally, the DMAS 97 A/B (Personal/Attendant Plan of Care), and the DMAS-100 (Request for Supervision Time under CCCP Waiver) have been revised and are available on the DMAS website under Provider Forms Search. Kepro will process requests with the old forms through May 31, 2019. On and after June 1, 2019 Kepro will require the updated forms to be submitted with requests for Personal/Attendant Care Services. Should old forms be submitted to Kepro on/after June 1, 2019 Kepro will reject the request for the new forms.

For Instructions for Submitting Medicaid Expansion Service Authorization Requests to Keystone Peer Review Organization (Kepro), refer to the following link: https://dmas.kepro.com/.

Effective September 1, 2018, service authorization requests for Early Periodic Screening, Diagnosis and Treatment (EPSDT) for personal care and attendant care will be reviewed by Keystone Peer Review Organization (Kepro). The DMAS Medical Support Unit’s (MSU) last day to receive EPSDT personal care requests is August 31, 2018. If you have a case that was pended by the DMAS MSU you must respond back to the DMAS MSU via the provider web portal Atrezzo, by the required time frame noted on the pend request. All other procedures are unchanged. For questions and all other inquiries regarding this change, contact the DMAS Helpline at 1-800-552-8627 or 804-786-6273. This initiative ended effective 4/30/19.

 

There are service authorization process changes that may impact your services to Kepro. Please review the following new Medicaid Memos to Providers available through the Virginia Medicaid Web Portal using the link below:

https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/MedicaidMemostoProviders

    1. Memo dated 10/19/2016 titled, "Changes to the Service Authorization (SA) of Organ and Stem Cell Transplants and Non-Emergency, Outpatient, Out of State MRI, PET and CAT Scans - Effective November 1, 2016”

 

    1. Memo dated 6/6/2017 titled, "Launch of Commonwealth Coordinated Care (CCC) Plus Waiver - Effective July 1, 2017”

 

  1. Memo dated 6/30/2017 titled, "Notification of Updates to certain EPSDT Service Authorization Forms for Fee-for-Service and Managed Care members and Transition of Clinical Reviews of Certain EPSDT Fee-for-Service Authorizations from Kepro to DMAS Medical Support Unit or DBHDS-Effective August 1, 2017"

Reminder: Service Authorization Expiration Dates

You may have members whose service authorizations will be expiring next month. If the member continues to need the services, you will need to submit a request for services to the Department of Medical Assistance Services designated service authorization contractor prior to the end of the current authorization. THERE ARE NO AUTOMATIC RENEWALS.

For services that are authorized by Kepro, the service authorization request may be submitted through direct data entry (DDE), fax, phone or and US mail. The preferred method is by DDE for a quicker response through Kepro’s provider portal, Atrezzo Connect. To access Atrezzo Connect on Kepro’s website, go to https://dmas.kepro.com/.


Durable Medical Equipment & Supplies (DME) changes related to Incontinence Supplies – Effective January 1, 2014

Based on the Request for Proposal (RFP) 2013-01, DMAS awarded a sole contract for the provision of Incontinence and Related Supplies for all Virginia Medicaid fee-for-service members to Home Care Delivered, Inc. Effective January 1, 2014, all Virginia Medicaid members will order and receive their incontinence supplies through Home Care Delivered. Please refer to the Virginia Medicaid Web Portal for current Medicaid Memos to providers relating to Incontinence Supplies for additional information at:

https://www.virginiamedicaid.dmas.virginia.gov/wps/portal

NEW! EFFECTIVE JUNE 30, 2018 [docx] The Department of Medical Assistance Services (DMAS) will end the Alzheimer’s Assisted Living (AAL) Waiver effective June 30, 2018.

NEW! EFFECTIVE AUGUST 1, 2017 [docx] Individuals served through the EDCD and Tech Waivers will automatically continue services through the CCC Plus Waiver. Click here for more information.

NEW! EFFECTIVE AUGUST 1, 2017 [docx] Changes in the submission of requests for EPSDT PDN, EPSDT School Based PDN, and EPSDT Personal Care services.

NEW! EFFECTIVE NOVEMBER 1, 2016 [docx] Organ and Stem Cell Transplants (in state and out of state) and Non-Emergency, Outpatient, out of state MRI, PET, and CAT scans will no longer be accepted by Kepro. These services will now be authorized by the Department of Medical Assistance Services (DMAS)/Medical Support Unit (MSU). For the purposes of this change, out of state is defined as any facility or provider not within the state of Virginia.

NEW! EFFECTIVE JULY 1, 2016 [docx] The Individual and Family Developmental Disabilities Support Waiver (DD Waiver) will be transitioning from Kepro to the Department of Behavioral Health and Developmental Services (DBHDS)!

NEW! EFFECTIVE JANUARY, 2016 [docx] The Department of Medical Assistance Services (DMAS) will begin covering Lactation counseling services and breast pumps for women enrolled in fee-for-service Medicaid/FAMIS/FAMIS MOMS. Click for information about breast pumps that require service authorization through Kepro.