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Effective 1/12/2015-GAP Services that Require Service Authorization through KEPRO

The Governor's Access Plan (GAP) for medical and behavioral health services is restricted to Virginia adults (ages 21 through 64) who have serious mental illness. This benefit plan includes limited medical services that require service authorization (srv auth) through KEPRO. Srv auth is required for the following Traditional medical services :

  • Non-emergent, outpatient Magnetic Resonance Imaging (MRI scan)
  • Non-emergent, outpatient Computerized Axial tomography (CAT scan)
  • Durable Medical Equipment: limited to overage Diabetic Supplies
  • Surgical Procedures (Specific procedure codes only)
  • Medical Device Services/Maintenance (specific procedure/HCPCS codes only)

**Only services performed in outpatient facility setting. All other are limited to physician office only. Physician office includes Rural Health Clinical9RHC ) and Federally Qualified Health Clinics (FQHC).

To access a complete listing of procedure codes/ HCPCS codes requiring authorization click " Training" tab   followed by  clicking "General" tab  next select document labeled  "Gap Procedure /HCPCS codes ".


Posted: 1/5/2015

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Service Authorization (Srv Auth) Checklists

Want to avoid hold-ups caused by missing information in Srv Auth requests? 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


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 foe 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

 

 


Posted: 12/3/2014


KEPRO is URAC accredited in Health Utilization Management, Disease Management and Case Management. We are also licensed to perform medical reviews in 29 states.

Atrezzo Connect is available for submission of all requests for Virginia Medicaid authorization. LOG IN or REGISTER here...

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