Services

Kepro provides medical necessity review on prior authorization and retrospective authorization requests for fee-for service Medicaid recipients only. 

Codes that require Prior Authorization: Codes not on this list DO NOT require prior authorization

Before logging into the provider portal, please ensure:

• Current eligibility has been checked thru the Medicaid eligibility system, MESA . If the patient is enrolled in a managed care program, you will need to contact that program directly for authorization.
• The patient does not have primary insurance. This includes Medicare part B. No authorization is required if the patient has other primary health insurance.
• You have a copy of the physician order and clinical notes ready for uploading into the review request.

American College of Radiology Appropriateness Criteria