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BiPAP and CPAP Improvements

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.

Posted: 7/2/2014

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. 



Posted: 5/22/2014

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

 

 



Posted: 11/12/2013

Prior Authorization Date Range

All Prior Authorization requests, whether Inpatient or Outpatient, are good for 180 days.

Posted: 10/16/2013

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.



Posted: 9/30/2013

Announcements


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 services.

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.

Atrezzo Connect is available for submission of all requests for HCHCP services. Click the button below to register and login.

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