Department of Medical Assistance Services
SERVICE AUTHORIZATION
The Department of Medical Assistance Services contracts with Keystone Peer Review Organization (KePRO) to handle the service authorization (srv auth) process for Medicaid, Family Access to Medical Insurance Security (FAMIS) and FAMIS Plus clients in the fee-for-service programs. The KePRO (srv auth) 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 specific CPT procedures listed in the Physician Manual);
  3. Certain waiver enrollment/service authorizations maintained by DMAS Long-Term Care
KePRO accepts srv auth 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 srv auth requirements and methods of submission may be found on the contractor’s website at http://dmas.kepro.com.

SERVICE AUTHORIZATION REQUEST SUBMISSION OPTIONS
  1. Overview of Service Authorization Contractor 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)

ANNOUNCEMENT

NEW! EFFECTIVE APRIL 1, 2012!! - CURRENT MEDICAL SUPPORT UNIT (MSU) SERVICES MOVING TO KEPRO FOR SERVICE AUTHORIZATION!!

Certain services currently reviewed by DMAS’ Medical Support Unit (MSU) will be reviewed by Keystone Peer Review Organization (KePRO), DMAS’ service authorization contractor. These services include: Organ Transplant Services (0300), Surgical Procedures (0302), Prosthetics 0303), and Medical Device services/maintenance (0304).

KePRO will begin accepting requests, regardless of the dates of service, on April 1, 2012. KePRO will allow retroactive reviews for service requests submitted through June 30, 2012 for all other procedure codes on the list that are not bolded or marked with asterisk. Effective July 1, 2012, KePRO will not authorize requests retroactively for these procedure codes, regardless of the dates of service.

KePRO will provide web based training sessions for providers starting March 23, 2012. Providers may access these training sessions by going to dmas.kepro.com and clicking on the Training tab.

The corresponding fax forms needed for service authorization are accessible below in the, "Service Authorization Fax Forms" section. The preferred submission method is through direct data entry (Atrezzo Connect). Also, the “action reason code” detail list for approvals and denials is accessible below under “Provider Resources”.

For more information please refer to Medicaid Memo dated March 9, 2012 on the Provider Web Portal at virginiamedicaid.dmas.virginia.gov under the Provider Services Tab. DMAS provider manuals are accessible on the Virginia Medicaid Web Portal, virginiamedicaid.dmas.virginia.gov and the KePRO website dmas.kepro.com.
FAQs for these services are accesible by clicking the link bellow in Provider Resources.


PROVIDER RESOURCES
FIPS Codes for Virginia Cities & Counties
Action Reason Detail Report
Atrezzo Connect Provider Reference Guide
KePRO Provider Training Schedule and Resources
DMAS Provider Training Schedule and Resources
Medicaid Memos to Providers
FAQs - Updated August 5, 2009
FAQs – KePRO
SERVICE AUTHORIZATION FAX FORMS
Community Based Care Waiver Request - DMAS-98
Procedures/Devices Service Authorization Request- DMAS 351
Inpatient Service Authorization Request - DMAS-362
Inpatient Psychiatric Continued Stay Review - DMAS-362A
Outpatient Service Authorization Request - DMAS-363
Substance Abuse Services Service Authorization Request - DMAS-363A
Treatment Foster Care Service Authorization Request - DMAS-364
Residential Treatment Care Service Authorization Request - DMAS-365
Residential Services for Children & Adolescents Level A/B Request - DMAS-365AB
IIH Service Authorization Request - DMAS-366
Community Mental Health Rehab Services PA Request - DMAS-367
CODES
ICD9 Diagnosis Codes
Revenue Codes for Home Health
Revenue Codes/Corresponding CPT Codes for Outpatient Rehab Services
CPT Codes For Radiological Scans
After clicking the link, please refer to the Table of Contents under the heading titled "Outpatient PET, CAT, and MRI CPT Code Requiring srv auth".