Department of Medical Assistance Services
SERVICE AUTHORIZATION
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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, 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 maintained by DMAS Division of Aging and Disability Services
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

*** Attention Providers**

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”

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

  3. 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"

ANNOUNCEMENT

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 http://dmas.kepro.com.

ANNOUNCEMENT

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

ANNOUNCEMENT

NEW! EFFECTIVE AUGUST 1,2017 KEPRO will begin service authorization for individuals participating in the Commonwealth Coordinated Care Plus (CCC Plus) Waiver.

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

NEW! EFFECTIVE NOVEMBER 1, 2016 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 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 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.

NEW! EFFECTIVE JANUARY 12, 2015 The Department of Medical Assistance Services (DMAS) will begin a two-year, state-wide §1115 demonstration waiver, entitled the Virginia Governor’s Access Plan for the Seriously Mentally Ill (GAP). Click for information about GAP Services that require service authorization through KEPRO.

PROVIDER RESOURCES
Bullett Action Reason Detail Report
Bullett Atrezzo Connect Provider Reference Guide
Bullett KEPRO Provider Training Schedule and Resources
Bullett DMAS Provider Training Schedule and Resources
Bullett Medicaid Memos to Providers
Bullett FAQs – KEPRO
SERVICE AUTHORIZATION FAX FORMS
Bullett Procedures/Devices Service Authorization Request- DMAS 351
Bullett Inpatient Service Authorization Request - DMAS-362
Bullett Outpatient Service Authorization Request - DMAS-363
CODES
Bullett ICD10 Diagnosis Codes
Bullett ICD9 Diagnosis Codes
Bullett Revenue Codes for Home Health
Bullett Revenue Codes/Corresponding CPT Codes for Outpatient Rehab Services
Bullett 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".