New Atrezzo Provider Portal
Kepro has upgraded Atrezzo to Atrezzo Next Generation (ANG). While ANG is still the same database system DMAS utilizes today, the upgrade provides users with a new look and feel that is highly intuitive and user-friendly.
Service Authorization Overview
The Department of Medical Assistance Services (DMAS) contracts with Acentra Health (formerly known as 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 Acentra Health (Service Authorization) contract excludes:
Services managed under a separate contract, including pharmacy, dental, transportation, 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
Behavioral Health information can be found on the Behavioral Health webpage.
ARTS (Addiction & Recovery Treatment Services) information can be found on the Addiction and Recovery Treatment Services webpage.
Acentra Health accepts service authorization requests via Atrezzo Next Generation (an interactive web-based application), telephone, paper, and fax submission. The preferred submission method is through direct data entry 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/.
DMAS Memo Overview: Hospital Providers to Submit Requests for Non-Resident Alien Emergency Inpatient Admissions to Kepro for Service Authorization - effective March 13, 2023
Effective March 13, 2023, Kepro will begin reviewing inpatient hospital requests for Non-Resident Alien emergency inpatient admissions when the member is in the following aid categories designated for and requiring emergency services:
- Aid Category 112 Expansion population/Modified adjusted gross income (MAGI) Adults
- Aid Category 113 Non-MAGI/ABD/Children
Inpatient hospital providers should submit their request through Kepro's secure portal, Atrezzo using service type 0400. Kepro will then 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 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.
Hot Topics
New Process for Submitting Service Authorizations
The Department of Medical Assistance Services (DMAS) is making significant changes to the process used to submit service authorization requests for Fee-for-Service (FFS) members. Effective November 1, 2023, all providers and managed care organizations who provide services to Medicaid and FAMIS members will submit service authorizations to Acentra Health (formerly known as KePro).
This change will affect providers who perform services for the following programs:
- All Behavioral Health and ARTS Services
- Baby Care Program
- Continuous Glucose Monitors
- EPSDT Private Duty Nursing
- EPSDT Private Duty Nursing MCO School Based Carve Out
- Out of State Imaging
- Genetic Testing
Acentra Health is offering a series of specific trainings for administrators, medical providers, behavioral health providers and others to learn about and understand the new process. It is critical that all staff involved in the service authorization request process register for and attend a training session.
For more information, read the Medicaid bulletin dated Sept. 18, 2023 and view the list of upcoming training classes.
Independent Assessment, Certification and Coordination Team (IACCT) Inquiry Form
In the coming weeks Acentra will publish on our Website the link to submit an online inquiry for Behavioral Health Residential Treatment for an Individual under the age of 21.
Visit our archive page to view training resources and documents created prior to 2022.
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 DMAS Medicaid Memo dated March 30, 2023.
Providers, if you recently received a License Expired Termination Notification, you DO NOT NEED TO TAKE ACTION. Due to outdated provider licensing information, some providers did not receive proper notification of license expiration. We are working expeditiously to reinstate all terminated service locations by early next week. A future notice will be sent to you requiring your updated licensing information to be submitted for continued enrollment. If you have any questions, please send them to: VAMedicaidProviderEnrollment@gainwelltechnologies.com.
CheckIt Feature here
Check out the Required Srv Auth Information Checklists. These handy reference lists will help you determine at a glance all the information required for each service type.
Announcements
The purpose of this bulletin is to inform Behavioral Health providers of actions they must take in order to continue to receive payments without interruption after November 1, 2023. Behavioral Health refers to both mental health (MH) and Addiction and Recovery Treatment Services (ARTS) providers.
Providers must take action as soon as possible in order to smoothly transition claims submissions to prevent interruption of payment for the November 1, 2023 go-live of the Service Authorization (SA) and Specialty Services contract.
NEW OFFICE LOCATION
We are pleased to announce that our office has moved to a new location at 6802 Paragon Place, Suite 440, Richmond Va. 23230 . Although mail forwarding will be in place, it is imperative your records are updated to ensure timely receipt of your mailed documents.
Fraud and Abuse
Medicaid fraud is a deliberate withholding or hiding of information or giving false information to get Medicaid or FAMIS Plus benefits. Medicaid fraud also occurs when a provider bills Medicaid for services that were not delivered to a Medicaid recipient, or if a recipient shares his/her Medicaid number with another person to get medical care. Anyone convicted of Medicaid fraud in a criminal court must repay the Medicaid program for all losses (paid claims and managed care premiums) and cannot get Medicaid for one year after conviction. In addition, the sentence could include a fine up to $25,000 and/or up to 20 years in prison. You may also have to repay the Medicaid program for any claims and managed care premiums paid during periods you were not eligible for Medicaid due to acts not considered criminal. Fraud and abuse should be reported to your local Department of Social Services or to the Department of Medical Assistance Services Recipient Audit Unit at (804) 786-0156.
This information can also be found in the Medicaid Manual.
If you suspect fraud and abuse related to any Medicaid services, you may contact our Compliance Officer at 888.827.2884 or via email at ProviderIssues@kepro.com.
Please also refer to the following link for additional information: Centers for Medicare & Medicaid Services- Medicaid Fraud Detection Program
Kepro is URAC accredited in Health Utilization Management and Case Management
We are also licensed to perform medical reviews in 29 states.