General Program Information
KePRO Maryland is contracted with the
Maryland Department of Health and Mental Hygiene (DHMH) to perform medical
necessity review for Medicaid beneficiaries who incur a hospitalization. Additionally,
KePRO is contracted to perform level of care review for the long term care patient
covered by Medicaid. KePRO’s current contract to perform these duties is in effect
through January 2011.
KePRO Maryland is part of KePRO, a national healthcare solutions company. In addition
to utilization review, KePRO also has a commercial line of business. KePRO also
has an integrated health care management line of business in addition to expertise
in performing an array of quality improvement focused activities.
All information submitted by providers to KePRO for any review must be submitted
via the iEXCHANGE software by MEDecision. All providers submitting review information
must obtain an iEXCHANGE provider ID.
To obtain an iEXCHANGE provider ID, call KePRO at 443-589-3000 or toll-free 866-581-6773.
One of KePRO’s Provider Service Representatives (PSR) will ask a few questions needed
to obtain a provider ID #. Once your provider ID # is assigned, you may call KePRO
at 443-589-3000 and one of the PSRs or help desk staff will help you learn how to
login and how to submit information. The entire process will take about 15 minutes.
KePRO also sponsors iEXCHANGE orientation classes through WEB-based instruction.
Please see the iEXCHANGE orientation schedule below. To make a reservation for iEXCHANGE
orientation, follow the instructions below.
iEXCHANGE Instructions and Training Materials
All providers, regardless of the service requested, are required to verify Medicaid
eligibility prior to submission of clinical information to KePRO. KePRO provides
review for fee-for-service Medicaid beneficiaries only.
Medicaid Managed Care beneficiaries seeking services that are covered through the
HealthChoice Program are not subject to review by KePRO. Contact the assigned MCO
for further instruction related to authorization. Eligibility may be obtained from
the Maryland Medicaid Eligibility Verification System at 1-866-710-1447 or by visiting
the website at http://www.emdhealthchoice.org.
Patients 65 years or older are normally covered under Medicare unless they are undocumented
or have long term care coverage through fee-for-service Medicaid. If a Medicare
beneficiary has exhausted the annual allocation of inpatient days and Medicaid coverage
is requested, a retrospective review is submitted for acute hospital admissions.
For any patient who has Medicare coverage, the provider must submit a Medicare explanation
of benefits EOB. The EOB should include the effective date of Medicaid coverage
and the reason Medicare coverage is no longer in effect. The EOB must be submitted
with the clinical information. KePRO is unable to process the review without the
EOB information.
Office:
11350 McCormick Road
Executive Plaza II, Suite 102
Hunt Valley, Maryland 21031
Telephone/FAX:
Phone: 866.581.6773
Acute Care Fax: 866.581.6771
Long Term Care/Community Services Fax: 866.581.6769
Email: Maryland@Kepro.com
Directions
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- Shari Glickman, MS, LCSW-C, Project Director, ext. 3037
- Lenaye Lawyer, MD, FACOG, Medical Director, ext. 3003
- Linda L. Gregory, RN MS, Nurse Review Manager, ext. 3004