KEPRO

Vendor Overview

Description of Services: KEPRO, a care management company, has worked with public program and commercial health insurance payers and employers for over 30 years. We currently service 250 commercial, public and federal clients.

KEPRO supports payers in the areas of Assessments & Eligibility, CM/UM, Appeals/Grievances, and Pharmacy Services.

Assessments & Eligibility - Comprehensive solutions for health risk assessments, HRAs plus Care Plans for the SNP market, behavioral health assessments and level of care determination analyses. More than 200,000 assessments completed annually including 25,000 face-to-face assessments. 20 years of experience assessing behavioral health and intellectual/developmental disabilities.

CM/UM – Specializing in complex and special needs populations. Over 1.4 million UM reviews performed annually. Serving 23 state Medicaid programs. Care coordination across providers, community resources and other stakeholders. 24x7 access to Behavioral Health Advice and Triage Line. URAC accredited in UM, CM & DM.

Appeals/Grievances – KEPRO is the largest appeals, denials and inquiry management vendor in the USA with 3,000 credentialed physicians & 500 clinician advisory and review panel. We manage more than 100,000 appeal hearings a year for both state and national contracts. URAC accredited IRO.

Pharmacy Services – KEPRO processes more than 7.1 million prior authorizations annually, conducts 120,000 Retrospective Drug Utilization Reviews annually and offers an intervention/analytics based opioid and pain management program.

Primary Service: Utilization/Care/Disease Management
Secondary Service: Pharmacy

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777 East Park Drive
Harrisburg, PA 17111
480.452.4704
http://www.kepro.com

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