How to Complete Virginia Medicaid Prior Authorization Forms: DMAS-351 and DMAS-362

A Virginia Medicaid prior authorization form goes to one of two places: for fee-for-service members, submit the DMAS-351 (or the DMAS-362 for inpatient stays) to Acentra Health through the Atrezzo portal, by mail, or by fax at 1-877-652-9329; for managed care members, submit the plan’s own form through that plan’s provider portal.1Virginia Medicaid. Service Authorization Which path applies depends entirely on the member’s coverage, so check the Medicaid card before you start filling anything in.

First, Confirm Fee-for-Service or Managed Care

The member’s card tells you whether they are in fee-for-service (FFS) Medicaid or enrolled with a managed care organization (MCO). That single fact determines the form, the submitter, and the reviewer.

FFS requests go to Acentra Health, the state’s contracted utilization review organization. Acentra accepts requests through the Atrezzo Next Generation web portal, by phone, by paper, or by fax. Direct entry through Atrezzo produces a faster response than paper or fax and generates immediate confirmation.

MCO requests go directly to the member’s plan on that plan’s form, through that plan’s portal or fax lines.2CoverVA. Health Plans Aetna Better Health providers, for example, submit through Availity or by fax, with different fax numbers for inpatient admissions, behavioral health, and long-term services.3Aetna Better Health. Prior Authorization for Providers Every plan runs its own submission channels; the member card identifies which plan.

Sending an FFS form to an MCO (or the reverse) doesn’t get forwarded. It gets rejected, and you start over.

Which Form to Use

Virginia Medicaid publishes several service authorization forms, each tied to a service type:4Virginia Medicaid Enterprise System. Service Authorization Related Forms

  • DMAS-351, Prior Review and Authorization Request. The general-purpose form for most service types, and the one to use if you are unsure.
  • DMAS-362, Inpatient Service Authorization Request. For inpatient hospital stays.
  • DMAS-363, Outpatient Service Authorization Request. For outpatient procedures and services.
  • DMAS-62, Private Duty Nursing Service Authorization.
  • DMAS-352, Certificate of Medical Necessity. Filed alongside another form to document clinical justification.
  • DMAS-7, Medical Necessity Assessment and Personal Care.

The DMAS-351 also handles changes to existing authorizations and cancellations, not just new requests.

For FFS members, Acentra reviews behavioral health and Addiction and Recovery Treatment Services (for FFS and FAMIS), EPSDT private duty nursing, inpatient hospital admissions, out-of-state imaging, genetic testing, certain nonemergency MRIs, CT scans, and PET scans, Baby Care Program services, and continuous glucose monitors.5Department of Medical Assistance Services. Service Authorization6Virginia Code Commission. Virginia Administrative Code 12VAC30-50-10 – Services Provided to the Categorically Needy With Limitations MCOs keep their own prior authorization lists, which don’t always match the FFS list.

One boundary worth flagging: prescription drug prior authorizations run on a separate pharmacy track with their own forms, not the service authorization forms above.7Virginia Code Commission. 12VAC30-130-1000 – Pharmacy Services Prior Authorization

Filling Out the DMAS-351

The DMAS-351 has two sections: a header with patient and provider identifiers, and a line item area for the requested services. Every field has to be complete. Blanks get the form rejected or faxed back for corrections.8Virginia Medicaid Enterprise System. DMAS-351 Prior Review and Authorization Request

Header Fields

Start by marking whether the request is new, a change, or a cancellation. Then complete:

  • Fields 4–7: Servicing provider ID, name, contact person, and phone number.
  • Fields 8–11: The member’s 12-digit Medicaid ID (from the card), last name, first name, and middle initial. Match the card exactly.
  • Field 12: Referring provider ID, if any.
  • Fields 13–15: Check boxes for non-paper attachments such as X-rays or photographs.
  • Field 16: Primary diagnosis code.
  • Field 17: The existing PA tracking number, required only if this is a change or cancellation.
  • Field 18: The PA Service Type code from the Provider Manual.

Line Items

Each form holds up to six line items. If you need more, use additional forms and number the pages in the top-right corner. Per line:

  • Fields 19–25: Procedure code type, procedure code (HCPCS or CPT), up to four modifiers, units requested, dollar amount, and a description of the service or item.
  • Field 26: The line number being changed or canceled, if applicable.
  • Fields 27–28: The “from” and “to” dates of service.
  • Fields 29–30: Provider signature and date.

Paper submissions go to Virginia Medical Assistance Program, P.O. Box 25507, Richmond, VA 23261. Attach clinical notes, physician orders, and any diagnostic results that back up the diagnosis codes on the form.

Filling Out the DMAS-362 for Inpatient Requests

Inpatient hospital admissions use the DMAS-362 rather than the DMAS-351. The form asks for more clinical detail because inpatient stays cost more and get reviewed more closely. You can submit up to 30 days before a scheduled procedure, as long as the member is eligible when you submit.9Virginia Medicaid Enterprise System. DMAS-362 Inpatient Service Authorization Request Form

Alongside the standard identifiers (12-digit Medicaid ID, member name matching the card, date of birth, sex), the DMAS-362 requires:

  • Submitting provider and facility NPI or API, Medicaid ID, and 9-digit zip code.
  • Admission date, admission status (urgent or elective), and up to five ICD-10 diagnosis codes with descriptions.
  • Number of days requested.
  • Attending physician Medicaid ID and NPI.
  • Severity of illness: a narrative covering the chief complaint, history of present illness, relevant past medical history, abnormal lab values, imaging findings, and physical exam results that justify hospitalization.
  • Intensity of services: the procedures, treatments, and services the patient will receive while admitted.

The severity-of-illness section is where most inpatient denials start. A vague summary won’t hold up. The reviewer needs specific abnormal findings and a clear explanation of why outpatient care wouldn’t be enough. Fax completed DMAS-362 forms to Acentra Health at 1-877-652-9329.

When to Expect a Decision

Under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), the decision windows tightened as of January 1, 2026, for both FFS and managed care plans.10Centers for Medicare & Medicaid Services. CMS Interoperability and Prior Authorization Final Rule CMS-0057-F

Those replaced the previous 14-day standard window.12Anthem. Virginia Medicaid Prior Authorization Report Providers who submit through Atrezzo can watch status in real time. The member receives a written letter with the decision and, if denied, the specific reason.

Why Forms Get Denied

Denials cluster into two categories: administrative errors and thin clinical justification. Both are avoidable.

Administrative problems that trigger rejection:

  • Blank fields, especially the 12-digit Medicaid ID, provider NPI, or dates of service.
  • Wrong or outdated ICD-10 diagnosis codes and CPT or HCPCS procedure codes, or codes that don’t match the documentation.
  • Patient identifier mismatches: misspelled names, wrong dates of birth, or names that don’t match the Medicaid card.
  • Eligibility gaps. The member’s coverage was terminated, or the service isn’t covered under their benefit category. Verify eligibility for the date of service before you submit.

Clinical denials usually mean the documentation didn’t establish medical necessity. The reviewer needs specific abnormal findings, a diagnosis that lines up with the requested treatment, and a reason less intensive alternatives wouldn’t work. A DMAS-362 with a one-sentence clinical summary will come back denied. Attach the clinical notes, lab results, and imaging reports. The form by itself rarely tells the full story, and everything on the form has to be substantiated in the medical record.13Virginia Code Commission. Virginia Administrative Code 12VAC30-60-5 – Applicability of Utilization Review Requirements

Two more habits help: use ICD-10 codes at their highest level of specificity (missing digits are a leading technical rejection), and keep the submission confirmation, whether an Atrezzo receipt, a fax confirmation, or a certified mail tracking number. If a filing-deadline dispute comes up, that receipt is your proof.

Appealing a Denial

Providers and members both have appeal rights when a prior authorization is denied. The route depends on coverage type.14Department of Medical Assistance Services. Appeals

FFS members and their providers file directly with DMAS. The denial notice states the filing deadline, which is 30 days from receipt in most cases.15Department of Medical Assistance Services. Virginia Medicaid / FAMIS Client Appeal Request Form Appeals can go through the DMAS Appeals Information Management System (AIMS) portal.

MCO members appeal to their plan first. If the plan upholds the denial, the member has 120 days to escalate to DMAS. There is no good-cause exception for a late MCO appeal filed with DMAS; the 120-day deadline is firm.

Providers who appeal a DMAS decision on their own behalf file a written notice of formal appeal within 30 days of the informal appeal decision, identifying each disputed matter in detail. A hearing officer holds a hearing within 45 days and issues a recommended decision within 120 days; the DMAS director then issues a final agency decision within 60 days of receiving that recommendation.16Legal Information Institute. 12 Virginia Administrative Code 30-20-560 – Formal Appeals

Whichever route you file, add clinical documentation that addresses the specific denial reason. A denial for insufficient medical necessity won’t turn over on the same paperwork. It needs new or more detailed evidence than the original submission carried.