Welcome to the Acentra Health

Virginia Website

About Acentra Health

For 19 years, Acentra Health has served as a strategic partner to the Virginia Department of Medical Assistance Services (DMAS), delivering mission-critical Utilization Management (UM), Prior Authorization, Service Authorization, and Appeals Management Services for more than 220,000 traditional Medicaid Fee-for-Service (FFS) Members. Our role extends beyond transaction processing to providing the clinical expertise, operational rigor, and analytics necessary to support policy implementation, regulatory compliance, program integrity, and access to quality care across the Commonwealth.

Scale and Operational Impact

Acentra Health administers a comprehensive clinical review and appeals infrastructure that supports Virginia Medicaid's most complex and vulnerable populations. In 2025, the organization completed more than 97,000 utilization reviews, including approximately 40,000 behavioral health reviews and 57,000 medical reviews, demonstrating the capacity to manage significant and growing service volumes while maintaining consistent quality, timeliness, and regulatory compliance.

Core Functions

Acentra Health provides:

  • Prior Authorization and Service Authorization reviews for medical, waiver, behavioral health, and substance use services.
  • Medicaid and CHIP Fee-for-Service appeals and provider second-level appeals reviews.
  • Inpatient and outpatient utilization management, hospice reviews, discharge planning, and care transition support.
  • Retrospective medical necessity and Medicaid compliance reviews.
  • EPSDT reviews and Treatment Foster Care level-of-care determinations.
  • Psychiatric Residential Treatment Facilities (PRTF) and School-Based Health services. Clinical consultation, policy support, and provider education across medical, behavioral health, and waiver programs, including SUD, SED, I/DD, AD, and TBI waivers.

Acentra Health remains committed to helping DMAS achieve its strategic objectives through clinically sound, data-driven utilization management and appeals services that strengthen program oversight, support regulatory compliance, and promote appropriate access to care for Virginia Medicaid Members.