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The purpose of this bulletin is to inform providers that effective December 1, 2024 Organ Transplants and BabyCare Homemaker service authorization reviews will transition to Acentra Health for fee for service (FFS) service authorization. 

The DMAS Medical Services Unit will accept requests for organ transplants through November 30, 2024. DMAS’s Health Care Services Division will accept requests for BabyCare Homemaker services through November 30, 2024. 

Starting December 1, 2024 requests for organ transplants and BabyCare Homemaker Services for fee for service members must be submitted to Acentra Health through Acentra’s secure portal Atrezzo Next Generation (ANG). Provders can log into ANG here  https://portal.kepro.com/Login/Login 

Health Departments will request extensions for BabyCare services, on behalf of the provider, when 124 hours within 31 days is exceeded. 

Providers must be registered in ANG before submitting requests. Here is the link to How to Register for ANG VA DMAS Atrezzo Provider Portal Administrator Training  

Additional notes for DMAS covered organ transplants 

1) Providers must always obtain 2 service authorizations for transplants  

1. SA for the organ transplantation – (requested first) under service type 0300 

2. SA for the hospital stay – (requested second) under service type 0400;                          providers are to use the same case ID for the organ transplant and the                inpatient hospital stay          

3. Hospital SA request must contain the Organ Transplant Case ID in the “Notes Field” in ANG. 

2) DMAS covers corneal transplants, however these do not require service authorization 

3) The DMAS Hospital and Practitioner Manuals, Ch V and SA Appendixes are located here Hospital | MES (virginia.gov) and here Practitioner | MES (virginia.gov)   

There is no change to the billing process. 

4) Acentra Health utilizes Change Healthcare InterQual criteria, pediatric and adult, for organ transplants 

In-State, Border State, and Out of State Requests for Organ Transplants  

Providers enrolled as in-state providers, or border providers must submit requests to Acentra Health via ANG.

Providers enrolled as out of state providers must submit via fax to DMAS Medical Support Unit (MSU) @ 804-452-5450. 

To determine if you are an in-state, border state, or out of state, providers can contact DMAS’s PRSS contractor Gainwell Technologies at the following methods

Phone: 804-270-5105 or 888-829-5373

Email: VAMedicaidProviderEnrollment@GainwellTechnologies.com 

BabyCare Homemaker Services 

Health Departments will request services on behalf of the servicing provider. When the pregnant or post partum member requires physician ordered homemaker services in excess of 496 units within a 31 calendar day period, the Health Department will submit a request to Acentra Health, along with the homemaker provider’s NPI for service authorization. The physician’s order or letter of medical necessity must include an end date for homemaker services and uploaded in the ANG portal.  

To avoid disruption to claims payment through FFS and the MCOs providers must periodically check the DMAS provider portal, also known as the Provider Services Solution (PRSS), to ensure that the provider's enrollment, contact information, and license information is up to date, for all of the provider's respective service locations. Under federal rules, MCOs and DMAS are prohibited from paying claims to network providers who are not enrolled in PRSS. Additional information is provided on the MCO Provider Network Resources webpage and includes links to resources, tutorials and contact information to reach Gainwell with any provider enrollment or revalidation related questions.  Dental providers should continue to enroll directly through the DMAS Dental Benefits Administrator, DentaQuest.