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Service Authorization Process for Technology Assisted Waiver Skilled Respite (Service Types 0960) Presented by: KePRO INTEGRATED CARE MANAGEMENT AND QUALITY.

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Presentation on theme: "Service Authorization Process for Technology Assisted Waiver Skilled Respite (Service Types 0960) Presented by: KePRO INTEGRATED CARE MANAGEMENT AND QUALITY."— Presentation transcript:

1 Service Authorization Process for Technology Assisted Waiver Skilled Respite (Service Types 0960) Presented by: KePRO INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT 1

2 KePRO accepts service authorization (srv auth) requests through direct data entry (DDE), fax and phone. Submitting through DDE puts the request in the worker queue immediately; faxes are entered by the administrative staff in the order received. For direct data entry requests, providers must use Atrezzo Connect Provider Portal. For DDE submissions, service authorization checklists may be accessed on KePRO’s website to assist the provider in assuring specific information is included with each request. To access Atrezzo Connect on KePRO’s website, go to 2 Methods of Submission Service Authorization Requests to KePRO 2

3 Please note that for Alzheimer's Assisted Living Waiver, all requests must be submitted via KePRO’s Atrezzo Connect System To access Atrezzo Connect on KePRO’s website, go to Provider registration is required to use Atrezzo Connect. The registration process for providers happens immediately on-line From providers not already registered with Atrezzo Connect may click on “Register” to be prompted through the registration process. Newly registering providers will need their 10- digit National Provider Identification (NPI) number and their most recent remittance advice date for YTD 1099 amount.http://dmas.kepro.com The Atrezzo Connect User Guide is available at : Click on the Training tab, then the General tab. 3

4 Service Authorization Requests: Contact Information for KePRO/ DMAS Provider Information Providers with questions about KePRO’s Atrezzo Connect Provider Portal may contact KePRO by at For service authorization questions, providers may contact KePRO at KePRO may also be reached by phone at , or via fax at OKBYFAX or

5 Service Authorization Information Specific to Skilled Respite under Technology Assisted Waiver The Technology Assisted Waiver (TW) provides medically appropriate and cost effective coverage of services necessary to maintain individuals in the community, who would otherwise remain in hospitals or specialized care facilities. 5

6 Service Authorization Information Specific to Skilled Respite under Technology Assisted Waiver Services Offered in Tech Waiver and authorized by DMAS: Skilled Private Duty Nursing (PDN) Personal Care Services- Agency Directed (Adults Only) Transition Services Congregate Nursing/Respite Services 6

7 Service Authorization Information Specific to Skilled Respite under Technology Assisted Waiver Services Offered in Tech Waiver and authorized by KePRO: Skilled Respite Care Assistive Technology Assistive Technology Maintenance Environmental Modifications Environmental Modification Maintenance 7

8 Service Authorization Information Specific to Skilled Respite under Technology Assisted Waiver Service Limits: Maximum of 360 hours may be authorized per calendar year The Authorization will span for 24 months Service Type: 0960-Technology Assisted Waiver Procedure Code: S9125 TE Agency Directed LPN Skilled Nursing S9125 TD Agency Directed RN Skilled Nursing 8

9 Service Authorization Information Specific to Skilled Respite under Technology Assisted Waiver Eligible Members for TW include individuals who: Have Medicaid FFS Are enrolled in TW prior to enrollment in TW respite as TW respite is not a stand alone service NOTE**Individual coverage shall not be provided for individuals who reside in board and care facilities, inpatients in general acute care hospitals, skilled or intermediate nursing facilities, or intermediate care facilities for the mentally retarded, specialized care, or long stay hospital 9

10 Service Authorization Information Specific to Skilled Respite under Technology Assisted Waiver Timeliness Requirements for Submission: Providers must submit documentation to KePRO within 10 business days of initiation of care If request is not submitted within 10 business days, the service must be authorized beginning with the date the information was received by KePRO If additional information is needed from the provider, the case is pended for 5 business days 10

11 Service Authorization Information Specific to Skilled Respite under Technology Assisted Waiver Required Forms and Documentation Requests can be submitted to KePRO by fax, phone, and/or direct data entry If submitting by fax, please include: DMAS 98 Completed CMS 485 and/or verbal order signed and dated by physician 11

12 Service Authorization Information Specific to Skilled Respite under Technology Assisted Waiver Required Forms and Documentation (cont) If submitting by Atrezzo Portal, please: Complete Tech Waiver Questionnaire Completed CMS 485 and/or verbal order signed and dated by physician NOTE**The information submitted must include clear documentation of need for the amount of Respite Care 12

13 Service Authorization Information Specific to Skilled Respite under Technology Assisted Waiver Transferring Respite Services from one agency to another: Transferring provider must submit DMAS 225 to KePRO with the effective discharge date The new provider will need to submit a request for services 13

14 Service Authorization Information Specific to Skilled Respite under Technology Assisted Waiver Criteria: Must be an unpaid Primary Caregiver Service may be provided in the member’s primary residence or to assist with transportation to medical appointments Must be enrolled in the TW by DMAS before processing respite service request Authorization for TW respite is contingent upon the approval for PDN by DMAS 14

15 General Information for All Service Authorization Submissions There are no automatic renewals of service authorizations. Providers must submit requests for continuation of care needs, with supporting documentation, prior to the expiration of the current authorization. Providers must verify member eligibility prior to submitting the request. Authorizations will not be granted for periods of member or provider ineligibility. Requests will be rejected if required demographic information is absent. Providers should take advantage of KePRO’s web based checklists/information sheets for the services(s) being requested. These sheets provide helpful information to enable providers to submit information relevant to the services being requested. Providers must submit a service authorization request under the appropriate service type. Service authorization requests cannot be bundled under one service type if the service types are different. 15

16 VIRGINIA MEDICAID WEB PORTAL DMAS offers a web-based Internet option to access information regarding Medicaid or FAMIS member eligibility, claims status, check status, service limits, service authorizations, and electronic copies of remittance advices. Providers must register through the Virginia Medicaid Web Portal in order to access this information. The Virginia Medicaid Web Portal can be accessed by going to: If you have any questions regarding the Virginia Medicaid Web Portal, please contact the Xerox State Healthcare Web Portal Support Helpdesk, toll free, at from 8:00 a.m. to 5:00 p.m. Monday through Friday, except holidays. The MediCall audio response system provides similar information and can be accessed by calling or Both options are available at no cost to the provider. Providers may also access service authorization information including status via KePRO’s Provider Portal at 16

17 ELIGIBILITY VENDORS: How to check for Member Eligibility DMAS has contracts with the following eligibility verification vendors offering internet real-time, batch and/or integrated platforms. Eligibility details such as eligibility status, third party liability, and service limits for many service types and procedures are available. Contact information for each of the vendors is listed below: –Passport Health Communications, Inc. Telephone: 1 (888) –SIEMENS Medical Solutions – Health Services Foundation Enterprise Systems/HDX Telephone: 1 (610) –Emdeon Telephone: 1 (877)

18 DMAS Helpline Information The “HELPLINE” is available to answer questions Monday through Friday from 8:00 a.m. to 5:00 p.m., except on holidays. The “HELPLINE” numbers are: – Richmond area and out-of-state long distance – All other areas (in-state, toll-free long distance) Please remember that the “HELPLINE” is for provider use only. Please have your Medicaid Provider Identification Number available when you call. 18

19 Provider Manual/Medicaid Memorandums Technology Assisted Waiver Services Manual DMAS publishes electronic and printable copies of its Provider Manuals and Medicaid Memoranda on the DMAS Web Portal at https://www.virginiamedicaid.dmas.virginia.gov/wps/portal. This link opens up a page that contains all of the various communications to providers, including Provider Manuals and Medicaid Memoranda. The Internet is the most efficient means to receive and review current provider information. If you do not have access to the Internet or would like a paper copy of a manual, you can order it by contacting: –Commonwealth-Martin at A fee will be charged for the printing and mailing of the manual updates that are requested. 19

20 Questions??? INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT 20


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