Virginia MedicaidMental Health Services Claims and Authorization Processes
Notice
We ask that all providers work directly with the CCC Plus MCO's directly for issue resolution. If there are issues that are unresolved by the MCO and for questions about the CCC Plus CMHRS services please forward inquiries to DMAS directly at: EnhancedBH@dmas.virginia.gov.
Processes
Medallion 4.0 and CCC Plus Eligibility Tracking Authorization and Claims Process for CMHRS
Forms
CCC Plus and Medallion 4.0 Forms for 2020
Contact Page Update (March 1, 2019): The last page of each form has been revised to reflect that, effective March 18, 2019, Virginia Premier will no longer be using Beacon to complete MLTSS CMHRS/ARTS/BH authorizations. ALL Lines of Businesses will now be completed in-house. The contact information on the last page of each form posted here has now been updated and now reflects the new contact information for Virginia Premier effective March 18, 2019. Continue using existing contact information for Virginia Premier until then. No other form content or MCO Contact information has been changed on these forms.
Contact Page Update (October 14, 2020): The fax numbers for Optima have been updated and can be found below in the document titled "MCO Authorization Contact Information Rev. 10.14.2020." Due to the frequency of changes made to the MCO Contact Information, the "MCO Authorization Contact Information" document will now just be a stand alone document and will no longer be added to the end of each of the authorization request forms. Questions? Please direct them to EnhancedBH@dmas.virginia.gov.
Forms Files
- Applied Behavior Analysis Initial Authorization Form - December 2021
- Applied Behavior Analysis Continued Stay Authorization Form - January 2022
- ARTS and MHS Registration Form - September 1, 2022
- Community Stabilization (S9482) Initial Service Authorization Form Effective February 14, 2023
- Community Stabilization (S9482) Continued Stay Authorization Form - February 14, 2023
- Community Stabilization Referral Form Optional Template September 2022
- Functional Family Therapy (H0036) Initial Authorization Form - December 2021
- Functional Family Therapy (H0036) Continued Stay Authorization Form - December 2021
- Multisystemic Therapy (H2033) Initial Authorization Form - December 2021
- Multisystemic Therapy (H2033) Continued Stay Authorization Form - December 2021
- Residential Crisis Stabilization Unit (H2018) Continued Stay Authorization Form - March 2023
- Enhanced Services ISP Template - December 2021
- ACT (H0040) Initial Authorization Form - July 2021
- ACT (H0040) Continued Stay Authorization Form - July 2021
- MH IOP PHP (H0035 or S9480) Initial Authorization Form
- MH IOP PHP (H0035 or S9480) Continued Stay Authorization Form
- CMHRS Continued Stay Request - December 2021
- Therapeutic Day Treatment (H2016) Initial Service Authorization - July 2021
- Med4 AVAPEC 1621 17 IIH Initial Authorization Form 42319
- MHSS (H0046) Initial Authorization Form April 2023
- Med4 AVAPEC 1623 17 PSR Initial Authorization Form 42319
Critical Incidents
Community Mental Health and Rehabilitation Services Education and Outreach
To find details on all upcoming trainings, please refer to: Acentra Health (formerly Kepro).
Information regarding upcoming trainings will be posted to the DMAS and Acentra Health websites. Recorded trainings will also be posted to both websites. Additional online training resources will be announced once the effective dates are finalized.
Acentra Health - Behavioral Health Service Authorizations
Behavioral Health Providers are encouraged to contact Acentra Health with questions about covered behavioral health services, service authorizations, grievances and complaints at: Contact Acentra Health
For assistance with billing, claims, member eligibility, memos and other regulations, call the Virginia Medicaid Provider Helpline at the toll-free (800-552-8627) or in-state (804-786-6273) phone numbers. The Provider Helpline is available Monday to Friday between 8 a.m. and 5 p.m.
Licensing / Credentialing / Registration Resources
Registration information for Qualified Mental Health Professionals (QMHPs) is located on the Board of Counseling Website - Qualified Mental Health Professionals
Registration information for Peer Recovery Specialists (PRS) is located on the Board of Counseling Website - Peer Recovery Specialists
Contact Virginia Department of Behavioral Health and Developmental Services (DBHDS)
DBHDS Office of Licensing
DBHDS Office of Human Rights
Virginia Department of Health Professions
Transportation Resources
For transportation information, visit: http://transportation.dmas.virginia.gov or http://www.logisticare.com