Medical Necessity Reviews
With the high cost of health care, it is imperative that insurers, managed care
organizations, health plans, and state and federal agencies know that the services
they are covering are medically necessary. You need an experienced, independent
review organization to provide an unbiased, evaluation of the care to ensure that
services and procedures are appropriate.
Since 1985, KePRO has provided CMS, state Medicaid programs, other federal agencies,
and some of the largest insurers and health plans with independent review services
to ensure that members receive the right care, at the right time, in the right setting.
We have reviewed over 17 millions cases, in all health care settings.
We are well-versed in federal and state review regulations, and adhere to all plan-specific
provisions. We are also URAC accredited in health utilization management, assuring
you that our review processes are efficient.
Nationally Recognized Criteria
KePRO uses InterQual® criteria for inpatient reviews, and Milliman outpatient
and ancillary services. We are also skilled at applying state and plan specific
criteria, when required. Using these nationally recognized criteria ensures clients
that our review determinations can withstand scrutiny and simultaneously secure
the integrity of the review process.
KePRO has 23 years of experience complying with criteria, regulations, and policies
in the Medicaid and Medicare arenas. In all of our Medicaid and Medicare work, we
have efficiently and effectively made determinations on prior authorizations, continued
stays, and reconsiderations in the acute care, psychiatric, transplant, durable
medical equipment, home health, mental health, outpatient therapies, and private
duty nursing settings.
For more information about KePRO’s medical necessity review services, contact our
Business Development professionals at 1.800.222.0771, or
email us today.
