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memo

The purpose of this memorandum is to inform providers about modifications to Virginia Medicaid’s Preferred Drug List (PDL) Program, and additions to the Enhanced Prospective Drug Utilization Review (ProDUR) Program (Maximum Quantity Limits and Dose Optimization), effective April 1, 2010.

memo

This memo is the first in a series regarding the transition of Medicaid’s Fiscal Agent and Provider Enrollment Services contracts. The Department of Medical Assistance Services (DMAS) will transfer all Fiscal Agent and Provider Enrollment Services functions from First Health Services Corporation (FHSC) to ACS State Healthcare on or shortly before July 1, 2010. We will provide the exact date in a subsequent memo. The transition to ACS does not involve the development and implementation of a new MMIS. Rather, ACS will be taking over the day-to-day operation of the current system and will be adding some new enhancements.

memo

The purpose of this memorandum is to inform providers of the Commonwealth Coordinated Care (CCC) Program that beginning July 1, 2015 all providers who provide services to individuals enrolled in CCC will be required to use a National Provider Identifier (NPI). Fee-for-service Medicaid providers who currently have an API are not required to obtain an NPI in order to bill DMAS. Continue to use your API for your fee for service claims and authorizations.

memo

The purpose of this memo is to inform providers of upcoming changes to the service authorization processes performed by Keystone Peer Review Organization (KEPRO), the service authorization administrator for the Department of Medical Assistance Services (DMAS). This is the first of two memorandums informing providers of upcoming changes.

memo

The purpose of this memorandum is to provide you with the Department of Medical Assistance Services (DMAS) general billing instructions for the new CMS-1500 (02-12) form. This new form will replace the current CMS-1500 (08-05) form for claims received on or after April 1, 2014.

memo

The purpose of this memorandum is to notify Home and Community Based providers of the status of the Elderly or Disabled with Consumer Direction (EDCD) Waiver services authorizations. The Department of Medical Assistance Services (DMAS) has instructed the service authorization contractor, KePRO, to perform an expedited review of all requests currently in the EDCD Waiver queue. Additional contract staff have been hired and DMAS’ staff deployed to assist in these efforts. This should result in clearing the backlog of agency and consumer-directed service authorizations by no later than September 27, 2013, and the payment of timesheets through October 2, 2013.

memo

The purpose of this memorandum is to inform you of changes to billable activities for individual supported employment services reimbursed through the Individual and Family Developmental Disabilities Support (DD), Intellectual Disability (ID), and Day Support (DS) Waivers. The 2013 Acts of Assembly, # 307. PPPP, requires the Department of Medical Assistance Services (DMAS) to realign the billable activities paid for individual supported employment provided under the Medicaid home-and community-based waivers to be consistent with job development and job placement services reimbursed by the Department for Aging and Rehabilitative Services (DARS).

memo

The purpose of this memorandum is to notify providers of criteria that were developed for children (birth up to age 21) with disabilities seeking long-term care services (such as nursing facility or home and community-based care waivers). This information is provided as guidance for pre-admission screening teams and hospital screeners to be used in addition to the existing pre-admission screening process. These guidelines do not replace the requirements for pre-admission screening using the existing process.

memo

The purpose of this memorandum is to inform you that the HIV/AIDS Waiver will expire on June 30, 2012. The Department of Medical Assistance Services (DMAS) will not renew the HIV/AIDS Waiver. All authorizations for HIV/AIDS Waiver services will end effective June 30, 2012 and no payment will be made for services provided through the HIV/AIDS Waiver after this date. Requests for HIV/AIDS Waiver enrollment or services received at KePRO for dates of service on and after July 1, 2012 will be rejected back to the provider.

memo

The purpose of this Medicaid memorandum is to notify outpatient rehabilitation agency providers that there will be no inflation adjustment to rates effective for dates of services on or after July 1, 2012 through June 30, 2014.