related links

• Overview
• Appeals
• Beneficiary Complaints
• Other Reviews
• Medical Record Electronic Submission
• Educational Resources
• Physician Acknowledgement Monitoring
• QIO Liaison
• Memorandum of Agreement
• Update Your Contact Information
• Case Status Check

overview

Kepro is a nationally recognized provider of healthcare management solutions in both state and federal government as well as commercial clients. We provide prior authorization, utilization and specialty review, and case and disease management services.

To accomplish our objectives, Kepro must have qualified peer reviewers who meet the following federal regulations:

• Must be a doctor of medicine, osteopathy, dentistry, podiatry, or optometry, or another individual who is authorized under Federal or State law to practice medicine, surgery, osteopathy, dentistry, podiatry, or optometry
• Have a current state license
• Are board-certified
• Must either be engaged in active practice in the State or be military physicians who actively practice in a military or Department of Veterans Affairs (DVA) healthcare facility. Active practice means that the physician usually practices (on a routine basis) a minimum of 20 hours per week. Active practice must also include active staff privileges in a healthcare facility on a regular basis. There are some exceptions to this requirement, notably that emergency department physicians and dentists who do not have admitting privileges in an acute care hospital can meet the requirement of active staff privileges as defined in this regulation.

For peer reviewers interested in working with Kepro on Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) reviews, there are three types of cases:

• Discharge Appeals
• Quality of Care
• EMTALA

interested in becoming a peer reviewer for kepro?

Thank you for your interest in becoming a credentialed peer reviewer or EAP provider for Kepro.
Please email the following three (3) documents:

1. Your CV or resume
2. Your CAQH (Council for Affordable Quality Healthcare) or your state specific credentialing application*
3. Kepro's Supplemental Questionnaire (Kepro's Supplemental Questionnaire - PDF)

* If you do not have a CAQH or state specific credentialing application, please email the following two (2) documents:

1. Your CV or resume
2. Kepro's Credentialing Application (Kepro's Credentialing Application - PDF)

Applying to be a credentialed provider does not guarantee work with Kepro. The Credentialing Team does not have access to case review reimbursement rates.

If you have further questions about becoming a peer reviewer or would like additional information, contact our Credentialing Department by e-mail at keprocredentialing@kepro.com.

what to expect with case review

Kepro provides liability coverage for peer reviewer activities, and the reviewer's name will remain confidential except instances where identification is required by law or by specific contact. We provide compensation for our reviewers based on the type of review or service being requested and/or amount allowed by the individual customer for whom the work is being performed. Compensation of services will be made withing 45 days of receipt of the completed report and invoice.

While we cannot guarantee any pre-established volume commitments, your approval as a credentialed will present you with opportunities to work with our organization in both the private and public sector.

peer review information

There are PowerPoint presentations below for more information on the two BFCC-QIO review types. 

Physician Education: CMS Guidelines Relevant to Appeals Reviews (PDF Format)

The Peer Review Process (PDF Format)