BiPAP and CPAP Improvements
have been made to the BiPAP and CPAP questionnaires. If your completed
questionnaire meets all medical necessity requirements, it will be auto
approved. If it does not, our clinical team will review it for medical
necessity and will provide you with a determination notification. You may
reference the updated questionnaires in our provider reference section.
Psychiatrist Referral Change Notice
Effective immediately, a referral to a psychiatrist may have a
maximum of 6 visits per request instead of the original 3 visits.
Revised 2013 Psych CPT Codes
We have revised the final determinations regarding the replacement of Psych Codes by Medicare for 2013 as follows:
For the HCHCP Plan, the following codes will be utilized for initial evaluations and pharmacologic management of and outpatient HCHCP Clients requiring authorized psychiatric evaluations and medication management:
Psychiatrist should not use the E&M Code for Initial Evaluation (Use crosswalk codes of 90791 and 90792)
Psychiatrist should use the appropriate E&M Code for Pharmacy Management including; 99211, 99212, 99213, 99214, and 99215. Please be advised that you must also add code 90863 which has a charge value of 0 to indicate it is for Pharmacy Management - otherwise it will not be paid.
Psychiatrist should use the Inpatient initial E&M Codes of 99221 and 99222
Psychiatrist should use the Subsequent Care E&M Codes of 99231 and 99232.
These changes are effective 11/4/2013
Prior Authorization Date Range
All Prior Authorization requests, whether Inpatient or Outpatient, are good for 180 days.
Pain Management CPT codes
Friendly reminder of the existing April-July 1 2010, Pain Management Guidelines and Process listed under the training tab labeled Pain Management. All CPT codes listed on the Pain Management document require prior authorization regardless of the specialty of the physician.
Hillsborough County HCHCP Cases submitted to KEPRO for Medical Necessity Review must be ‘Prior Authorized’ and approved before the date of service takes place. Hillsborough County Health Care Plan does not approve of any Retrospective Cases in which the Submission Date of the Case is after the Requested Dates of Service. Therefore, KEPRO has created a ‘rule blocker’ in Atrezzo and the portal to block the submission of a case based on the rule that the submission date cannot be greater than the request start, which means that same day requests will pass. This will block any provider from submitting any ‘retrospective’ cases.
There are no announcements at this time.
Keystone Peer Review Organization, Inc. (KEPRO), an industry leader in providing
innovative, value-added healthcare management solutions, has been awarded the "Medical
Management and Services" contract through Hillsborough County's Health and Social
Services. The Hillsborough County (HCHCP) contract ensures appropriate, quality-driven
care through quality improvement of specified inpatient hospital, medical and surgical
Recognized as the largest federally designated Quality Improvement Organization
(QIO) in the nation, KEPRO's reputation is a result of providing many years of innovative
healthcare management solutions to multiple state Medicaid and Medicare programs,
the Department of Defense's (DoD) national TRICARE program, and 5 of the nation's
largest insurance providers.
The Internet based system uses InterQual criteria to safeguard against unnecessary
or inappropriate use of Medicaid services and provides clients with an enhanced
secure system to perform accurate, confidential medical record review through a
remote-user, virtual private network.
KEPRO is URAC accredited in Health Utilization Management, Disease Management and Case Management. We
are also licensed to perform medical reviews in 29 states.