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Appeals & Grievances

Kepro balances accuracy with efficiency during the appeals and grievances process.

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Experienced support for providers and patients

Kepro performs appeals and grievances on behalf of CMS and state Medicaid agencies and commercial plans. We protect the rights of members by making timely and informed decisions. Our seasoned team works collaboratively with both members and providers to support many different appeals including:

  • 1st and 2nd Level Medical Necessity Reviews
  • Medical Appeals (State & Federal Levels)
  • ACA Appeal Requirements
  • 3rd Party Appeals
  • Testifying for Fair Hearings

Kepro performs more than 1.8 million reviews of all types and completes more than 130,000 Medicaid appeals on an annual basis for our clients.


Expertise to make high-accurate decisions

With more than 500 clinicians and 3,000 credentialed physicians on our physician panel, we have the expertise needed to do all types of specialty matches. These individuals use established nationally recognized criteria, alongside current medical guidelines, to make highly-accurate decisions. In addition, we manage grievances by acting as a mediator to resolve issues between members and their providers while thoroughly investigating the grievance.

We protect the rights of members by making timely and informed decisions

1.8 million

Appeals reviewed annually


Credentialed Physicians


Medicaid appeals reviewed annually


Flexible process based on your organization's unique systems

We also provide education on the appeals process. Throughout these efforts, Kepro maintains a flexible process based on your organization’s unique systems, regulatory criteria, time frames and requirements. As a result, your team can focus on other mission-critical functions like managing claims while we take on these resource-intensive processes.