The Keystone Peer Review Organization, Inc. (KePRO), headquartered in Harrisburg,
Pennsylvania, is a privately held, for profit subsidiary of the Pennsylvania Medical
Society. Founded in 1985, KePRO has evolved into a national quality improvement
and care management company whose solutions focus on improving health outcomes while
reducing health care administrative costs for commercial and public clients. We
are URAC accredited in both utilization health management and case management.
Medicare Quality Improvement Organization (QIO)
From 1985 – 2002, KePRO held the CMS QIO contract for the state of Pennsylvania.
Since 1999, Ohio KePRO, a wholly-owned subsidiary
of KePRO, has held the QIO contract for Ohio. We have conducted numerous special
studies under the Medicare QIO contract throughout the years.
Medicaid Programs
Beginning in 1992, KePRO expanded into the Medicaid market; we now successfully
administer contracts in Florida, Maryland, Virginia, and Tennessee. We provide Medicaid
utilization management and medical appeals services for both fee-for-service and
managed care enrollees.
Commercial Services
In 1996, KePRO created a subsidiary called KePRO Acquisitions, Inc, to serve the
commercial health care market. From 1996-2009, we were doing business as (dba) HealthQuest.
Now we market KePRO Care Management Solutions™ under KePRO. We market our solutions
to numerous large insurance companies, health plans, health systems, third party
administrators, trust physicians and providers who are purchasing agencies.
In May 2006, KePRO acquired a minority interest in
ITA Partners, Inc., a Philadelphia-based cancer management firm. ITA Partners
improves medical and financial cancer outcomes by providing case management of newly-diagnosed
cancer patients, empowering patients and their families to make informed decisions
throughout every phase of cancer care.
Other Federal Programs
KePRO is a full participant in the GSA Advantage! Program, the federal government’s
approved vendor system designed to eliminate the costs and time frames associated
with the procurement process.
KePRO is listed on the Multiple-Award Schedule (MAS). We have negotiated fees for
skill sets to perform the following services:
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Utilization Management
Prior Authorization
Admission Review
Appeals
Medical Record Abstraction
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Quality Reviews
Retrospective Review
Coding
EMTALA
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Precertification
Concurrent Review
Coding Validation
Reconsiderations
Medical Malpractice/ Risk Management Review
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Under the GSA schedule, KePRO was successful in winning the Medical Claims Review
and Risk Management Services contract for the Federal Tort Claims Act (FTCA) Deemed
Health Centers and Free Clinics, part of the Health Resources & Services Administration
(HRSA). Since 2004, KePRO has provided ongoing expert medical malpractice reviews,
risk and claims management recommendations, and claims trend data for the FTCA Program.
Today
Overall, KePRO has assessed health care in some capacity for nearly 17 million lives
in both the public and commercial marketplaces. We are licensed to perform medical
review in 29 states. KePRO offers the following integrated care management portfolio
that improves individual health outcomes while reducing administrative costs:
Integrated Care Management
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Appeal and Review Services
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Offices
Our six offices – Harrisburg, Tampa, Baltimore, Cleveland, Nashville,
and Richmond – are home to over 300 clinicians and other dedicated professionals.
We also offer access to a physician review panel of over 3,200, including representation
for all major subspecialties.