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:
- Services managed under a separate contract, including pharmacy, dental, transportation, Behavioral Health, Intellectual Disability & Day Support Waivers, and managed care organization (MCO) vendor services;
- 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;
- 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
- Overview of Service Authorization Contractor [pdf] and Atrezzo Connect Web Based Application;
- Atrezzo Connect - Log In;
- U.S. Mail - Kepro 6802 Paragon Place, Suite 440, Richmond VA, 23230;
- Telephone - 1-888-VAPAUTH (827-2884) 804-622-8900 (local);
- Fax - 1-877-OKBYFAX (652-9329)
- Expansion requests: https://dmas.kepro.com/
Emergency Medicaid Service Authorization Requirement - Effective March 13, 2023
Effective March 13, 2023, Kepro will begin reviewing inpatient hospital requests for nonresident alien emergency inpatient admissions when the member is in the following aid categories designated for non-resident aliens who require emergency services:
- Aid Category 112 Expansion population/Modified adjusted gross income (MAGI) Adults
- Aid Category 113 Non-MAGI/ABD/Children
Inpatient hospital providers are to submit their request through Kepro's secure portal, Atrezzo, using service type 0400. Kepro will review the request for emergency hospital admissions. Since inpatient hospital requests are only for emergency services for this population, qualifying admissions must be preceded by treatment and transfer from an Emergency Department (ED) with appropriate physician certification for inpatient services.
For admissions prior to July 1, 2022, providers are to reference the Physician/Practitioners Manual and the Hospital Manual, Chapters 4, in both manuals. For admissions on and after July 1, 2022, providers must refer to the Emergency Medicaid Non-Resident Alien Supplement.
Hospital to Hospital Transfers
Documentation for transfers will include initial hospital ED records, inpatient admission certification, and discharge note/transfer summary to support that emergent care is still necessary. Transfers are for treatment that the initial hospital cannot provide, usually a higher level of care.
Grace Period for Providers
From March 13, 2023, through April 30, 2023, Kepro will waive timeliness for the inpatient hospital admission when the aid category is 112 and 113. This grace period will allow admission dates of service from July 1, 2022 – April 30, 2023 to be submitted without timeliness penalty, as long as the case is submitted by April 30, 2023 in Atrezzo. Kepro’s Atrezzo system is available 24/7 for submission of requests.
Refer to the DMAS Medicaid Memo dated March 30, 2023.
Provider Memo Updates
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:
- Memo dated 03/11/2022 titled, "Preparations to Resume Normal Eligibility and Enrollment Operations: Member Toolkit and Resource Information - Effective March 11, 2022"
- Memo dated 03/11/2022 titled, "DMAS Transition from VAMMIS To Medicaid Enterprise System (MES): Key Functions for Fee for Service Providers - Effective March 30, 2022"
- Memo dated 03/10/2022 titled, "Update to the Durable Medical Equipment and Supplies, Appendix B Update - Effective January 1, 2022"
- Memo dated 03/10/2022 titled, "Coverage of Remote Patient Monitoring/Update to Telehealth Services Supplement - Effective May 1, 2022"
- Memo dated 03/04/2022 titled, "DMAS Replacing VAMMIS With Medicaid Enterprise System (MES): Key Dates For Providers - Effective starting March 30, 2022"
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/.
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/.
Service Authorization Fax Forms