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:
-
Services managed under a separate contract, including pharmacy, dental,
transportation, Mental Retardation & Day Support Waivers, and managed care
organization (MCO) vendor services;
- Authorizations maintained by DMAS Medical Support (Organ Transplants, Gastric Bypass,
Cosmetic Procedures, Prostheses, and specific CPT procedures listed in
the Physician Manual);
- 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.
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.