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DMAS and KePRO Your Key to PA

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DMAS and KePRO Your Key to PA

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    1. DMAS and KePRO Your Key to PA

    2. 2 Program Changes and Updates Check out the Medicaid Memos and Manuals on line It’s easy: Go to the DMAS website at www.dmas.virginia.gov and click on the link to Providers Services or Go to the KePRO website at http://dmas.kepro.org

    3. 3 PA SERVICE TYPE SELECTION SELECT ONE OF THE SERVICE TYPES WHICH APPLY TO YOUR PA REQUEST: 9999 INTENSIVE IN-HOME 0050 OUTPATIENT PSYCH SERVICES 0092 ORTHOTICS(EPSDT) 0093 EPSDT INPATIENT PSYCH 0100 DME 0200 INTENSIVE REHABILITATION 0201 CORF 0204 OUTPATIENT REHAB 0401 INPATIENT PSYCHIATRIC 0450 MRI 0451 CAT 0452 PET 0500 HOME HEALTH 0625 ELDERLY CASE MANAGEMENT 0700 TREATMENT FOSTER CARE 0750 CSA RESIDENTIAL TREATMENT 0751 NON-CSA RESIDENTIAL TREATMENT 0900 EDCD WAIVER 0902 DD WAIVER 0920 AIDS WAIVER 0960 TECH WAIVER (EXCLUDING PDN AND RESPI) 0400 INPATIENT ADMISSION

    4. 4 Submitting PA Requests via iEXCHANGE The preferred method of submission for PA requests is through iEXCHANGE at http://dmas.kepro.org Providers can use iEXCHANGE to submit requests 24 hours a day, seven days a week Registration is required and once completed, providers can expect to receive their iEXCHANGE user login and password by email within 10 business days

    5. 5 Submitting PA Requests via iEXCHANGE Need Help? A step-by-step iEXCHANGE user manual, an on-line pre-recorded training presentation with iEXCHANGE demo, and other helpful resources are available on the KePRO website at: http://dmas.kepro.org/default.aspx?page=iexchange

    6. 6 Submitting PA Requests Requests also may be submitted via Telephone: 888-827-2884 or 804-622-8900 (local) Fax: 877-652-9329 or Mail to: KePRO 2810 North Parham Road, Suite 305 Richmond, VA  23294 Do not send duplicate requests via multiple faxes, iEXCHANGE, etc. unless specifically instructed by KePRO to re-send. This only clogs up the system and slows the process

    7. 7 Submitting PA Requests via Fax Updated PA request fax forms are now posted on the DMAS and KePRO websites The forms have been updated based upon provider feedback, and are available in two formats: (1) a PDF version that providers can download and complete manually; and, (2) an editable Word version, that allows providers to save the form and input responses directly. Use of editable version of the PA request form will expedite processing

    8. 8 Submitting PA Requests via FAX When submitting by fax and/or mail, providers must use the updated fax forms and should include all relevant clinical information in the Severity of Illness (SI) and Intensity of Service (IS) boxes Please do not state “see attached” or “meets criteria,” and do not send attachments with the fax forms, except as noted in fax form instructions KePRO is unable to alter any information submitted on PA requests Providers are responsible for providing accurate and correct information on their PA requests

    9. 9 Submitting PA Requests for Waivers The preferred method of submission for PA requests for waiver services is through iEXCHANGE; however, requests may be submitted via fax, telephone, or mail Please note that PA requests for waiver enrollments must be submitted by fax or mail and must include a thoroughly completed copy of the individual’s Uniform Assessment Instrument (UAI) screening form PA requested “from” and “through” service dates are required for all PA submissions. However, for certain waiver services, an “open” through date (12/31/9999) is no longer acceptable Under KePRO, all dates entered must be “valid” and the new open through date format is equal to six (6) years beyond the “from” date of service. The through date for “open” waiver PAs will be systematically auto-renewed by KePRO prior to the PA expiration date. This new “open” end-date change applies to newly added and/or updated prior authorizations. Providers are not required to change existing waiver prior authorizations (e.g., those on file with a “12/31/9999” authorized through date)

    10. 10 Submitting Additional Information To submit additional information on an open case iEXCHANGE Providers may submit additional information through iEXCHANGE by choosing "add to comments." (NOTE: The "extend case" feature is to be used when requesting additional days of coverage except for inpatient med/surg admissions.). Whenever a provider adds to comments, this puts the case back in the nurse review queue FAX / PHONE Providers may receive a notice from KePRO requesting additional information. Providers should submit additional information by following the instructions received from KePRO on the "fax-back" notice

    11. 11 Receiving a PA Number

    12. 12 Receiving a PA Number

    13. 13 Receiving a PA Number

    14. 14 Retro Reviews

    15. 15 Overlapping Dates

    16. 16 Overlapping Dates

    17. 17 ICD-9 Codes

    18. 18 Procedure Codes

    19. 19 Procedure Codes

    20. 20 Procedure Codes

    21. 21 Revenue Codes

    22. 22 Verifying Eligibility

    23. 23 Questions

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