Clarifications of Registration Requirements Covering Peer Recovery Support Services for Medicaid Members – Effective July 1, 2021.
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The purpose of this memorandum is to provide clarifications to the Department of Medical Assistance Services (DMAS’) registration requirements covering Peer Recovery Support Services (PRSS) within Addiction and Recovery Treatment Services (ARTS) and Mental Health benefits.
In May 2021, DMAS implemented changes to the initial and concurrent registration requests processes for PRSS to allow for registration approvals for six months’ duration. This change helped to streamline the registration process for providers of PRSS for Virginia Medicaid members. DMAS is now further streamlining the requirements for providers to submit registrations and be reimbursed for PRSS within the ARTS and Mental Health benefits.
To reduce the administrative burden for all parties involved in the service delivery system, DMAS revised the registration form to include both ARTS and Mental Health for PRSS effective July 1, 2021. In addition, providers will no longer be required to submit additional documentation with the registration form such as the Recovery, Resiliency and Wellness Plan, PRSS certification, PRSS Supervisor training, or letter of recommendation effective July 1, 2021. Providers must keep the required documentation in the employee’s record and the member’s medical record. The PRSS Staff Roster will continue to be required by the Medicaid Managed Care Organizations and Magellan of Virginia for new PRSS staff as well as when there is a PRSS staff change.
Medicaid members must meet applicable medical necessity criteria for services being requested at the time of the request and remain eligible for services throughout the billing period as defined in the Peer Recovery Support Services Supplement.
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PROVIDER CONTACT INFORMATION & RESOURCES |
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Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
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Medicall (Audio Response System) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
1-800-884-9730 or 1-800-772-9996 |
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KEPRO Service authorization information for fee-for-service members.
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Provider Appeals DMAS is launching an appeal portal in late May 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal. |
https://www.dmas.virginia.gov/#/appealsresources
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Managed Care Programs Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE). In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider. The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals. |
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Medallion 4.0 |
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CCC Plus |
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PACE |
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Magellan Behavioral Health Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members. |
www.MagellanHealth.com/Provider For credentialing and behavioral health service information, visit: www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or Call: 1-800-424-4046 |
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Provider HELPLINE Monday–Friday 8:00 a.m.-5:00 p.m. For provider use only, have Medicaid Provider ID Number available. |
1-804-786-6273 1-800-552-8627 |
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Aetna Better Health of Virginia |
www.aetnabetterhealth.com/Virginia 1-800-279-1878 |
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Anthem HealthKeepers Plus |
1-800-901-0020 |
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Magellan Complete Care of Virginia |
1-800-424-4518 (TTY 711) or 1-800-643-2273 |
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Optima Family Care |
1-800-881-2166 www.optimahealth.com/medicaid |
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United Healthcare |
and www.myuhc.com/communityplan 1-844-752-9434, TTY 711 |
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Virginia Premier |
1-800-727-7536 (TTY: 711), www.virginiapremier.com |