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
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.
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
Service Authorization Requests
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
Independent Assessment, Certification and Coordination Team (IACCT) Inquiry Form
Click here to use the IACCT inquiry form to submit an online inquiry for Behavioral Health Residential Treatment for an Individual under the age of 21.
License Expired Termination Notification
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 Due to outdated provider licensing information, some providers did not receive proper notification of license expiration.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. 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
Service Auth Information Checklists
Check out the required Service 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.
Acentra Health - 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
Popular DMAS Links:
- 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 is URAC accredited in Health Utilization Management and Case Management
We are also licensed to perform medical reviews in 29 states.