Company Overview
The Keystone Peer Review Organization, Inc. (KePRO) is committed to advancing the
quality and efficiency of health care delivery.
KePRO is…
Clinically driven. You want to keep your participants at their
best. KePRO is dedicated to ensuring that your total population gets the care they
need, when and where they need it. We were founded by the Pennsylvania Medical Society
on that simple philosophy. Our staff medical directors ensure that our solutions
are evidence-based, leading to better health outcomes for your total population.
Value based. Your population is unique. Why settle for an off the
shelf solution? Our flexibility enables us to provide programs that best target
your population’s needs and deliver the results you expect. We are the right size
to solve your health care issues, and are known for the high quality services we
deliver to clients of all sizes.
Client focused. You want an experienced vendor that will be there
for you year after year, improve the overall health of your population, and control
your care costs. KePRO has serviced the commercial and public health care markets
for over a quarter of a century.
- KePRO Wellness
- Utilization Management
- Case Management
- Chronic Care Management
- Maternity Management
- Appeals
Headquartered in Harrisburg, Pennsylvania, we are a privately held, for profit subsidiary
of the Pennsylvania Medical Society. Founded in 1985, KePRO has evolved into a national
quality improvement and care management company whose integrated solutions focus
on improving health outcomes while reducing care costs for commercial and public
program clients.
Overall, KePRO has assessed health care for over 19 million lives. We are licensed
to perform medical review in 27 states, and have URAC accreditation in health utilization
management, case management and disease management.
Throughout our history, we have provided services to numerous clients, including:
|
Public programs
|
Commercial
|
- Centers for Medicare & Medicaid Services (CMS)
- Department of Defense, TRICARE
- HRSA
- State Medicaid programs
- County governments
|
|
Our suite of integrated care management solutions can help you reduce costs associated
with overutilization and help improve the health of participants by managing their
conditions.
Ohio KePRO is the quality improvement organization
(QIO) for Ohio. We protect the rights and improve the health of Ohio’s 1.8 million
Medicare beneficiaries. We work with providers to improve the care they deliver
in support of the Department of Health and Human Services’ National Quality Strategy
to transform America’s health care system.
KePRO serves as the TRICARE Quality Monitoring Contractor.
We provide independent, impartial evaluation of health care services provided to
Military Health System beneficiaries. We also provide medical malpractice review
for HRSA.
KePRO is also a full participant in the GSA Advantage! Program, the federal government’s approved
vendor system designed to eliminate the costs and time frames associated with the
procurement process. KePRO is listed on the Multiple-Award Schedule (MAS).
KePRO works with state Medicaid agencies to ensure that recipients receive medically
necessary services in the appropriate setting. We have held contracts in seven states;
currently we provide services in South Carolina, Virginia
and Tennessee. We provide utilization management and medical necessity
appeals services for both fee-for-service and managed care recipients.
We also perform on site fraud and abuse activities to ensure services are physician
ordered, medically necessary, and delivered appropriately.
Our offices in Harrisburg, PA; Orlando, FL;
Cleveland, OH; Dallas, TX; Nashville, TN; and Richmond, VA – are home to over 250 clinicians
and other dedicated professionals. We also offer access to a physician review panel
of over 3,200, including representation from all major subspecialties.
KePROis seeking physicians in all subspecialties and other health care professionals
to serve as peer reviewers across all health care settings and in all states. You
can help ensure that patients are getting quality care in the most appropriate setting
by becoming a peer reviewer. Learn more or apply today!
If you are already a KePRO peer reviewer, log in now.