We use our review acumen to identify methods to improve the delivery of services across the care continuum through data analysis, provider cooperation, quality controls, technology, and innovative approaches. We perform prior authorization to determine if services:

• Are reasonable, necessary, and delivered in the appropriate setting
• Have documentation to support DRG assignment
• Meet professionally recognized standards of health care, including the completeness, adequacy, and quality of care provided.
• Are in compliance with state and federal policies, administrative rules, and regulations.

We assist the clinical staff in meeting length of stay goals for each pre-certified patient. We also ensure that any extension of services for ongoing medical/surgical care and treatment are necessary and received at the appropriate level of care.

We perform review after services have been delivered to ensure that the stay and all services rendered during that stay met medical necessity guidelines.

We also use utilization management to identify enrollees who would benefit from more intensive care management services. Early identification and engagement allows your enrollees to better management their conditions and lead healthier, more productive lives. Better management reduces your health care costs.

And because we have a single platform, we can seamlessly move your enrollees to other care management programs as their health needs change. Our integrated care management programs include: (below are links to pub prog products pages)

• KePRO Wellness
• Case Management
• Chronic Care Management
• Maternity Management.