Hot Topics
Coming Soon: New Health Coverage for Adults
Beginning January 1, 2019, more adults living in Virginia will have access to quality low cost health coverage. Eligibility is based on income, with a single adult making up to $16,754, or a family of three making up to $28,677, qualifying for coverage. Get more information at www.coverva.org
Posted: 7/6/2018
Alzheimer’s Assisted Living (AAL) Waiver
The Department of Medical Assistance Services (DMAS) will end the Alzheimer’s Assisted Living (AAL) Waiver effective June 30, 2018. KEPRO’s last day to receive continuation of care requests for Alzheimer’s Assisted Living (AAL) Waiver is June 30, 2018. If you have a case that was pended by KEPRO you must respond back to KEPRO via the provider web portal Atrezzo, by the required timeframe noted on the pend request. All case authorizations that end past waiver closure date will be end dated for June 30, 2018. For questions and all other inquiries regarding this change, contact the DMAS Helpline at 1-800-552-8627 or 804-786-6273.
Posted: 6/26/2018
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
Early and Periodic Screening, Diagnosis, and Treatment ( EPSDT) Services and CCC Plus Waiver- Effective September 1, 2018
Effective for Services beginning on or after September 1, 2018, individuals under the age of 21 in the CCC Plus Waiver must receive personal care, private duty nursing, and assistive technology through EPSDT benefit. Service authorization request for these services are to be submitted to either the respective Managed Care Organization (MCO) for individuals enrolled in managed care or KEPRO through the Atrezzo Connect provider portal for Fee-for-Service. The Managed care plan and KEPRO will utilize EPSDT rules and required documentation in authorizing these services.
Posted: 7/17/2018
REMINDER: ICD -10 Diagnosis Codes
ICD-10 Diagnosis codes became effective 10/01/2015. For any NEW case with a start of care or admission date 10/01/2015 or later, ICD-10 diagnosis code MUST be used. For any case with a start of care or admission date of 09/30/2015 or earlier ( regardless of the end date or submittal date) , ICD-9 diagnosis codes must be used.
Posted: 7/6/2018
EFFECTIVE 8/1/2017 – Changes in the submission of requests for EPSDT PDN, EPSDT School Based PDN, and EPSDT Personal Care services.
Effective 8/1/2017, requests for EPSDT PDN, EPSDT School Based PDN, and EPSDT Personal Care will be accepted and reviewed for medical necessity by the DMAS Medical Support Unit (MSU). Providers will continue to submit requests through KEPRO’s secure portal, Atrezzo. The requests will be processed by DMAS MSU within the preexisting standard of 5 business days.
Please refer to the DMAS Provider Memo dated, 6/30/2017 Notification of Updates to certain EPSDT Service Authorization Forms for Fee-for-Service and Managed Care members and Transition of Clinical Reviews of Certain EPSDT Fee-for-Service Authorizations from KEPRO to DMAS Medical Support Unit or DBHDS – Effective August 1, 2017 for additional details. This is available from DMAS at: https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/MedicaidMemostoProviders
For more information, contact the DMAS Helpline at 1-800-552-8627 or 804-786-6273.
Posted: 7/28/2017
EFFECTIVE 8/1/2017 – Service Authorization of Commonwealth Coordinated Care Plus (CCC Plus) Waiver Begins!
Effective 8/1/2017, KEPRO will begin service authorization for individuals participating in the CCC Plus Waiver. Please refer to the DMAS Provider Memo dated, 7/19/2017 Revised Launch of Commonwealth Coordinated Care Plus Waiver— Effective July 1, 2017 for additional details. This is available from DMAS at: https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/MedicaidMemostoProviders.
For more information, contact the DMAS Helpline at 1-800-552-8627 or 804-786-6273.
Posted: 7/28/2017
KEPRO is URAC accredited in Health Utilization Management and Case Management. We
are also licensed to perform medical reviews in 29 states.