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This is the second in a series of Medicaid bulletins DMAS is sharing prior to April 4, 2022. These bulletins inform Medicaid fee-for-services providers about the upcoming transition of several key information management functions currently handled through the Virginia Medicaid Management Information System (VAMMIS) to a new technology platform called the Medicaid Enterprise System (MES). Beginning April 4, providers will be required to use the new MES to access all functions described in this bulletin.

This bulletin provides additional information regarding the upcoming pause in provider access to VAMMIS. Specifically, information for providers of Long-Term Services and Supports (LTSS). The bulletin will also explain the new MES system with an emphasis on the benefits that the MES Provider Services Solution (PRSS) and PRSS Provider Portal tool will offer providers. This bulletin will also address how providers will access key functions using the new PRSS Provider Portal beginning April 4.

VAMMIS off-line from March 30 through April 3, 2022

Several functions within the existing VAMMIS website will be temporarily off-line beginning Wednesday, March 30, 2022 resuming Monday, April 4, 2022. A previous bulletin posted on March 4, 2022 titled DMAS is replacing parts of VAMMIS with Medicaid Enterprise System (MES): Key dates for providers lists the functions affected, key dates and where to go for assistance. The bulletin is located in Medicaid Bulletins and Bulletins to Providers at

https://www.virginiamedicaid.dmas.virginia.gov/wps/portal.

There will be no disruption in enrollment or financial eligibility for our Medicaid members during this pause to VAMMIS. During this temporary pause, providers should continue to provide all health care services to Medicaid members who present proof of eligibility in the form of a blue and white Medicaid ID card, a notice of approved eligibility from the Department of Social Services or a card for a managed care health plan.

Electronic Medicaid Long Term Services and Supports Screening (eMLS) to replace ePAS

One of the information systems changes with the launch of MES is the shutdown of the current electronic Medicaid Long Term Services and Supports (LTSS) system, known as ePAS, and the launch of a new system called Electronic Medicaid LTSS Screening (eMLS). (You can read more about these systems again later in this bulletin).

Long-Term Services and Supports (LTSS) screenings while VAMMIS is off-line

Providers will not be able to access the LTSS electronic screening system beginning March 30.  In addition, providers attempting to enroll individuals using the Long-Term Care (LTC) function for nursing facility care or to confirm completion of the LTSS screening will not be able to do so after March 29.

LTSS screenings entered before 3 p.m. on March 28 will be processed and the results will be viewable through VAMMIS, ePAS, or the Long Term Care (LTC) system until 11:59 p.m. on March 29. Any screening that is successfully processed in the ePAS system will transfer and be viewable through the new eMLS system beginning April 4. Any LTSS screening that is not successfully processed must be entered as a new screening in eMLS on or after April 4.

After 3 p.m. on March 28, LTSS screeners will not be able to enter screenings into the electronic system. LTSS screeners must continue performing the screenings using the NEW upload form DMAS-P98, but they must wait to enter the information into the eMLS on or after April 4. 

For all screenings conducted after 3 p.m. March 28 through April 3, LTSS screeners must securely attach and submit a copy of the DMAS-P98 to screeningassistance@dmas.virginia.gov.   Nursing facility providers must contact screeningassistance@dmas.virginia.gov to request a review of the submitted DMAS-P98 (LTSS screening) for any admissions occurring during the offline time period.  DMAS LTSS Screening staff will review the submitted DMAS-P98 and notify the provider by email that the individual is either not authorized or provisionally authorized for nursing facility (NF) enrollment.

For members known to be enrolled in the Commonwealth Coordinated Care Plus (CCC Plus) managed care program, NFs must continue to notify the Managed Care Organization (MCO) of admissions and discharges via the DMAS-80 form.  CCC Plus Waiver providers must continue to submit authorization requests for new waiver enrollees to the MCO.  Once an MCO validates that criteria are met for NF or waiver admission, the MCO will enter that information into the DMAS LTC portal.

The Level of Care Evaluation Review Instrument (LOCERI) portal will also be unavailable March 30 through April 3.  Providers should continue to perform LOCERI reviews during this time but wait until April 4 to submit them into the new LOCERI portal.

Commonwealth Coordinated Care Plus Waiver while VAMMIS is off-line

Providers should continue to submit CCC Plus Waiver authorizations and waiver enrollments for members not enrolled in a managed care to Kepro in accordance with current requirements.  Providers who cannot submit a request into Kepro's system due to the VAMMIS outage, must wait to request services on April 4, 2022 when VAMMIS will be accessible again (through MES PRSS). The authorizations and enrollments will be entered on or after April 4, 2022. Kepro will waive timeliness requirements through April 8, 2022 for all service types.

Developmental Disability Waivers (DDW) while VAMMIS is off-line

Providers will not be able to access the current portal for waiver level of care or authorization.  Service Authorizations entered before 3 p.m. on March 28 will be processed and the results viewable through the existing VAMMIS website until 11:59 on March 29. These authorizations will transfer and be viewable through the new MES beginning April 4.

Providers will continue to submit service authorization requests through the Waiver Management System (WaMS) during this period in accordance with current requirements.  After 3 p.m. on March 28, the Department of Behavioral Health and Developmental Services (DBHDS) will not be able to enter authorizations into VAMMIS nor will WaMS transfer that data. DBHDS will continue to review requests, but must wait to enter the information into VAMMIS using the new MES PRSS Provider Portal, on or after April 4.

What is MES?

The Medicaid Enterprise Solution or MES is DMAS’s new Medicaid Management System. The new system will enable DMAS to meet federal requirements for newer, more flexible, upgradeable, and secure information systems technology. MES will enable DMAS to respond more nimbly to changes in industry, policy, and technology requirements, and providers will experience more efficient and reliable responsiveness from DMAS because of the improved access to information.

Provider Support Through PRSS

The Provider Services Solution (PRSS) module will maintain comprehensive information on all enrolled providers, as well as access to various provider functions and helpful links to other resources.  PRSS is supported by DMAS through a contract with Gainwell. (Gainwell is replacing Conduent as the DMAS contractor for Provider Enrollment Services.) Beginning April 4, PRSS will include access to a live PRSS Provider Helpline between 8 a.m. and 5 p.m., Monday through- Friday, to assist providers with enrollment, revalidation, and PRSS Provider Portal account access questions. (The PRSS Provider Portal Helpline phone number will be 888-829-5373.)

What is the Provider Portal?

The PRSS Provider Portal is a tool within the new PRSS that eases the completion of various required Medicaid-related tasks. Using the PRSS Provider Portal will minimize paper transactions and improve the accuracy and efficiency of information exchanges between the provider and DMAS. Using the PRSS Provider Portal, providers will create a PRSS Portal on-line account, enroll and revalidate their enrollment, make changes to personal or business information, check member eligibility, and access the Virginia Medicaid Management Information System (VAMMIS). Newly enrolling providers seeking to contract with Managed Care Organizations, the Behavioral Health Services Administrator, or the Dental Network will all use the PRSS Provider Portal to initiate enrollment procedures starting April 4.   

What happens to VAMMIS?

Beginning April 4, the VAMMIS website (Virginia Medicaid Provider Portal) will no longer be the access point for users of MMIS. Providers will access MMIS by logging on to MES, accessing the new PRSS Provider Portal, then clicking on the desired function (e.g., check member eligibility, check claim status) and being transferred to MMIS. Conduent remains the contractor that manages MMIS on behalf of DMAS. For assistance with claims, claims adjudication, member eligibility, and information about covered services and limitations, contact the Conduent Provider Helpline at 800-552-8627.

What should I do before April 4?

• Complete MES training courses and download MES user guides. (See table below for suggested courses and downloads.) Providers can find a complete listing of training opportunities, links to training videos and downloadable documents, as well as registration for on-line “live” training at https://vamedicaid.dmas.virginia.gov/training/providers
• Watch for an email from DoNotReply@healthinteractive.net. The primary account holder for enrolled providers will receive an email from DoNotReply@healthinteractive.net. The email will contain login credentials and a link to the MES home page.
•  Complete the MES access registration process. Primary account holders will be able to access MES beginning March 21 and complete the system registration process. 
• Set up delegate account users, if applicable. Beginning March 21, primary account holders for providers registered with MES may access their provider portal account and assign delegate user access to their account. Delegate users are clerical and administrative office staff who need access to the provider portal to support the daily operations for an enrolled provider (e.g., to submit claims on the provider’s behalf).
• Make sure you are able to include proper taxonomy codes with your claims. Beginning March 25, providers must use taxonomy codes on all claims, with the exception of pharmacy NCPDP Point of Sale claims. Contact your practice management systems vendor immediately and make sure that you can submit your taxonomy codes on all Medicaid claims. You can find listings of taxonomy codes on the MES website.
• If not currently registered to use the current VA Medicaid provider portal, you must register for access to the new MES Provider Portal in order to access electronic remittance advices.

What should I do beginning April 4?

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