Inflation for Outpatient Rehabilitation Rates, Effective July 1, 2019

Bulletin

July 2, 2019, 9:39AM

To:

All Providers of Outpatient Rehabilitation Services Participating in the Virginia Medical Assistance Programs and Medicaid Managed Care Organizations (MCOs)

From:

Jennifer S. Lee, M.D., Director DMAS

The purpose of this bulletin is to inform you that effective July 1, 2019 the rates for outpatient rehabilitation providers will be increased to reflect a 3.00% inflation adjustment.

PROVIDER CONTACT INFORMATION & RESOURCES

Virginia Medicaid Web Portal Automated

Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

www.virginiamedicaid.dmas.virginia.gov

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

This action is in accordance with Chapter 12 of the Virginia Administrative Code, Section 30-80200, which mandates the annual inflation adjustment for outpatient rehabilitation providers.

Outpatient Rehabilitation rates, effective July 1, 2019, may be found on the DMAS web site at:

www.dmas.virginia.gov .

Medicaid Expansion

New adult coverage begins January 1, 2019. Providers will use the same web portal and enrollment verification processes in place today to verify Medicaid expansion coverage. In ARS, individuals eligible in the Medicaid expansion covered group will be shown as “MEDICAID EXP.” If the individual is enrolled in managed care, the “MEDICAID EXP” segment will be shown as well as the managed care segment, “MED4” (Medallion 4.0), or “CCCP” (CCC Plus). Additional Medicaid expansion resources for providers can be found on the DMAS Medicaid Expansion webpage at: http://www.dmas.virginia.gov/#/medex .

KEPRO

Service authorization information for fee-forservice members.

https://dmas.kepro.com/

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.

Medallion 4.0

http://www.dmas.virginia.gov/#/med4

CCC Plus

http://www.dmas.virginia.gov/#/cccplus

PACE

http://www.dmas.virginia.gov/#/longtermprograms

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