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How to submit a Seclusion and Restraint Report:

Click here: Provider Guide on submitting Seclusion & Restraint Report

Independent Assessment, Certification and Coordination Team (IACCT) Inquiry Form 

Effective November 1st, 2023, all inquiries can be submitted to Acentra Health using the following link: IACCT Inquiry Form

Please refer to the IACCT Roadmap for additional information regarding the process.

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, regardless of date of service, 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

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. 

https://vamedicaid.dmas.virginia.gov/memo/hospital-providers-submit-requests-non-resident-alien-emergency-inpatient-admissions-kepro 

 

Please see the Summer Newsletter (click on the Newsletters tab at the left) for Atrezzo Training information.

2023 SPRING Newsletter- NOW AVAILABLE  

Kepro's Newsletters include reminders, helpful tips and updates. To access the most recent Kepro newsletter, click on the Newsletter tab located on the left side of the homepage.

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.

Announcements

DMAS Memo Update (Changes to Claims/Payment Process for Behavioral Health Providers-effective November 1, 2023

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 & 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 for Investigation Program

Kepro is URAC accredited in Health Utilization Management and Case Management

We are also licensed to perform medical reviews in 29 states.