The DMAS-98R form is Virginia Medicaid’s service authorization request for home and community-based services and certain EPSDT services. A provider completes it to ask prior authorization for care like private duty nursing, personal care, or assistive technology, and sends it to Acentra Health, which processes service authorizations on behalf of the Department of Medical Assistance Services. You can download the current Word document from the DMAS Provider & Health Plan Resources page at dmas.virginia.gov.1Department of Medical Assistance Services. Provider & Health Plan Resources
Which Services the Form Covers
The DMAS-98R handles two categories of requests: CCC Plus Waiver services for members in Virginia’s home and community-based waiver, and EPSDT services for children under 21 who need intensive medical support. You’ll pick one of six service authorization type codes on the form:2Anthem Blue Cross and Blue Shield. Home and Community Based Services Request Form
- 0900 — CCC Plus Waiver, member not receiving private duty nursing
- 0960 — CCC Plus Waiver, member receiving private duty nursing
- 0090 — EPSDT Private Duty Nursing
- 0091 — EPSDT Personal/Attendant Care
- 0092 — EPSDT Assistive Technology
- 0098 — EPSDT Private Duty Nursing in School (MCO members)
Choose carefully. The wrong code routes the request to the wrong review team and delays the decision.
Completing the Form Section by Section
Member Identification
Enter the member’s full legal name, date of birth, and Medicaid ID number exactly as they appear on the Medicaid card. A mismatch with Virginia’s enrollment records is one of the fastest ways to get a form kicked back.
Provider Information
Include the National Provider Identifier (NPI) or Atypical Provider Identifier (API), along with the name and contact details of the provider who will actually deliver the service. The form’s instructions are specific on that point.3Virginia Medicaid. DMAS 98R Home and Community Based Services Request Form
Service Authorization Type
Mark the four-digit code from the list above that matches the service being requested.
Clinical Information
This is where most requests are won or lost. Include the primary diagnosis with current ICD coding, a description of the member’s functional limitations, the specific skilled services needed, and the frequency required. Be concrete. “Member requires suctioning every two hours due to tracheostomy and inability to clear secretions independently” tells a reviewer far more than “member needs nursing care.” Attach recent physician orders, hospital discharge summaries, and nursing assessments that back up the clinical picture.
Physician Signature
A Virginia-licensed physician must sign and date the form to certify medical necessity. An unsigned form is rejected at initial screening. If the physician signs electronically, confirm the signature meets Virginia’s electronic signature standards before you submit.
The Standard the Clinical Section Has to Meet
Medicaid will authorize private duty nursing only for skilled care, not custodial care. Skilled care is medically necessary care that can only be delivered by or under the supervision of licensed medical professionals: wound care, catheter management, respiratory therapy, intravenous injections, tracheostomy care, and similar interventions.4Centers for Medicare & Medicaid Services. Custodial Care vs Skilled Care Custodial care is non-medical help with daily activities like bathing, dressing, cooking, and laundry that an unlicensed caregiver can safely provide. Documentation that only shows a need for custodial help will not support a private duty nursing authorization.
For private duty nursing specifically, Virginia regulation requires individual, continuous nursing care that a physician has certified as medically necessary to keep the member out of a hospital or nursing facility. It must be one-on-one and cannot overlap with skilled nursing, personal assistance, respite, or companion services during the same hours. For a waiver-enrolled individual under 21 who qualifies for private duty nursing through EPSDT, the EPSDT benefit covers the service rather than the waiver.5Virginia Code Commission. Virginia Administrative Code 12VAC30-122-480 – Private Duty Nursing Service
Where and How to Submit
All DMAS-98R submissions go to Acentra Health. The preferred route is direct data entry through the Atrezzo portal at atrezzo.acentra.com, which gives the fastest turnaround.6Virginia Medicaid. Service Authorization If you don’t have an account, register on the portal’s login page.7Acentra Health. Atrezzo – Login
Acentra also accepts submissions by fax and by phone at 1-888-827-2884.8Department of Medical Assistance Services. Service Authorization If you fax, send every supporting clinical record in the same transmission. After submitting, you should receive a tracking number. Keep it. That’s how you’ll check status.
How Long the Decision Takes
As of January 1, 2026, federal rules require standard service authorization decisions within seven calendar days of a complete request. The clock starts when Acentra receives everything it needs. If the reviewer needs more information, the timeline can be extended up to 14 additional calendar days, but only when the extension is in the member’s interest or the provider or member requested it.9eCFR. 42 CFR 438.210 – Coverage and Authorization of Services
For urgent situations where delay could seriously jeopardize the member’s life, health, or ability to function, request expedited review. Expedited decisions must be issued within 72 hours.9eCFR. 42 CFR 438.210 – Coverage and Authorization of Services When you ask for expedited handling, document why the standard timeline poses a risk.
If your submission is incomplete, Acentra may pend the request and ask for records. Respond fast. Every day spent gathering paperwork eats into the member’s authorization window. Once the review closes, you’ll get a determination letter approving, denying, or partially authorizing the service for a specific period. Keep that letter; it’s the proof of coverage you’ll need for billing.
If the Request Is Denied
A denial can be challenged. Most managed care denials must go through the MCO’s internal appeal before the member can request a state fair hearing, so check the denial letter for that requirement first. A state fair hearing request must be filed with the Appeals Division within 120 days of the MCO’s final internal appeal decision.10Virginia Code Commission. Virginia Administrative Code 12VAC30-120-650 – Appeal Timeframes Federal rules also guarantee members at least 90 days from the mailing date of the denial notice to request a hearing.11eCFR. 42 CFR 431.221 – Request for Hearing
Focus the appeal on the exact reason for denial, which is usually insufficient documentation of medical necessity. Gather clinical evidence that closes that specific gap. A letter from the treating physician with specific clinical findings, explaining why the member’s condition requires skilled intervention, is often the strongest new piece of evidence you can add.
Don’t Embellish the Clinical Record
False or misleading information on a service authorization request carries consequences well beyond a denial. The federal False Claims Act imposes civil penalties per false claim plus up to three times the government’s damages.12eCFR. 28 CFR Part 85 – Civil Monetary Penalties Inflation Adjustment The HHS Office of Inspector General can also exclude a provider from all federally funded healthcare programs, which bars payment for anything the provider furnishes, orders, or prescribes and exposes any organization that hires them to further penalties.13Office of Inspector General, U.S. Department of Health and Human Services. Exclusions Program Document what the clinical record actually shows.