1. Atrezzo Provider Portal Outpatient Case Creation July 2015 INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT 1

2. Accessing Atrezzo Provider Portal Website Address: https://dmas.kepro.comhttps://dmas.kepro.com Select “ Atrezzo Login” To Register for Atrezzo Provider Portal : Enter your 10 digit National Provider Identifier (NPI) number and Provider Registration Code: YTD 1099 amount or Date of last Remittance advice received. If you are a new provider please contact KEPRO customer service at 1-888-827-2884 to obtain your registration code Registered Provider- Enter your unique user name and password **If you are a new or existing provider registering for Atrezzo Connect and you have multiple NPI numbers, you must register those NPI numbers under your administrative account in Atrezzo Connect. ** 2 2

3. Atrezzo Provider Portal KEPRO Atrezzo Provider Portal allows for: –Secure access to Atrezzo Connect (Provider Portal) –Via Atrezzo the provider will be able to access service authorization letters by case ID or Medicaid number, respond to pend request, and send/ receive messages to and from a Clinical Reviewer. – Provider submits service authorization request 3 3

4. Atrezzo Provider Portal Successful Completion of setup/login, takes you to the Home Page Click “New Request” to start your case creation 4 4

5. Atrezzo Provider Portal Complete member search utilizing the Members Virginia Medicaid ID # or Last name and Birthdate 5 5

6. Atrezzo Provider Portal Ensure accuracy of the members name and Medicaid ID prior to proceeding. Click “ Select” under the actions column 6 6

7. Atrezzo Provider Portal 7

8. 8

9. Member Detail information will display. Ensure accuracy of the members name and Medicaid ID prior to proceeding. Once verification is complete click “ Next” to continue. 9

10. Atrezzo Provider Portal Requesting provider information can only be changed if you have more than 1 NPI number registered to your Atrezzo Provider portal account. To change the requesting provider you must cancel your existing case creation and select the applicable provider from the change context section.. Note: Enter in the FAX # where official communication about this service authorization should be sent. 10

11. Atrezzo Provider Portal The servicing provider information will automatically default to reflect the providers name listed in the change context section ( Top Center of your screen ). If the listed provider is not applicable to the requested authorization click “Find” to complete a provider search. 11

12. Atrezzo Provider Portal **Attending Physician Section is optional** 12

13. Atrezzo Provider Portal Select the applicable service type from the drop down listing(Selection of the incorrect service type will delay case processing time) Request Type= Prior Auth (New request), Retro ( Retrospective review due retroactive Medicaid eligibility FIPS Code= Does not apply (Leave option blank) 13

14. Atrezzo Provider Portal Click “ Find” to complete CPT code search. 14

15. Atrezzo Provider Portal Examples of T1019 ( Wavier services) and 0421 (Outpatient Rehab) procedure code search. Click “Select” under the Actions column to place the selected code on case entry *Recommendation: Complete search utilizing cpt code versus description to minimize search results 15

16. Atrezzo Provider Portal Enter requested date span utilizing the calendar dropdowns Enter the quantity ( Units) Select the applicable frequency( Waiver services only) from the drop down listing Rate: Enter rate if applicable to your service Modifier- Select Modifier from Drop down listing ( Only if appropriate for your selected service type More than 1 procedure code repeat the above steps 16

17. Atrezzo Provider Portal Enter Diagnosis code by clicking “ Find” ***Recommendation: Complete search utilizing Diagnosis code versus description to minimize search results 17

18. Atrezzo Provider Portal First diagnosis code entered is automatically deemed as primary diagnosis. More than one diagnosis code repeat same steps. 18

19. Atrezzo Provider Portal Optional- Enter Clinical documentation to support the requested services Enter Contact name and Telephone number 19

20. Upload required documentation- Click “Browse” locate the file and click open to attach. File Name will appear when it is successfully uploaded ( refer to slide 22 for steps 2-4 ) Step 1 Atrezzo Provider Portal 20

21. Step 2 Step 3 Step 4 Atrezzo Provider Portal 21

22. Atrezzo Provider Portal Click questionnaire link to begin Once completed click “Save Changes” and “Mark as Complete”. Upon completion of questionnaire click the “Return to Request” link ( Located upper right corner ) Link will be displayed here 22

23. Atrezzo Provider Portal Click the check box of the case entry page acknowledging the below statement. Successful case entries requires selection of “ Submit”. Request overview page will now display your case entry and KEPRO case id number. Selecting “Save for Later” Saves the case entry up to the current point. Case will reflect on the provider Atrezzo Provider Portal home page awaiting final submission. ***Note: Case is not received by KEPRO until receipt of KEPRO case ID on the Request overview page.*** 23

24. Atrezzo Provider Portal Once a request is successfully submitted the following page will display. KEPRO case ID number is located to the upper left 24

25. Atrezzo Provider Portal Additional Trainings documents: Refer to Atrezzo Provider Portal user guide located under “HELP” tab within your Atrezzo Provider portal account. KEPRO Customer Service Department at 1-888-827-2884 OR atrezzoissues@KEPRO.com 25