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FAQ ID:
28
Answer: Facility
FAQ ID:
29
Answer: Depending on how we receive the information, you can either enter as a note in iEXCHANGE or send via fax to KePRO.
FAQ ID:
30
Answer: The following reviews can be submitted through iEXCHANGE: elective admission preauthorization, emergency admission, retroactive eligibility reviews, retrospective 3808 processing and medical eligibility reviews. Depending on the review type forms such as the 3808’s and 3871’s and 3871b’s will be accessible through iEXCHANGE for data capture. Or, you can fax information to KePRO. If faxing, you can use existing 3808 and 3871b. in addition, you can download forms from our website: www.kepro.o
FAQ ID:
31
Answer: Yes they are; however, if patient remains in hospital, a date for concurrent review submission will be provided by KePRO at the time of pre-auth.
FAQ ID:
32
Answer: Fax back to physician’s office
FAQ ID:
33
Answer: Yes, search by member id. this will provide a detailed list of cases
FAQ ID:
34
Answer: In iEXCHANGE notes if submitted electronically, or via fax is submitted via fax
FAQ ID:
35
Answer: This is an unique 9-digit internal tracking number. It shows that a case has been submitted to KePRO. We will need this for 3808 processing if a patient admission has been submitted.
FAQ ID:
36
Answer: his is not required in KePRO’s system since we will be receiving eligibility files. You will use Medicaid #, or name and date of birth
FAQ ID:
37
Answer: KePRO submits daily uploads of files to the state based on what has been processed for each day. The state will continue with their existing process.
FAQ ID:
38
Answer: Supporting documentation can be faxed in. Forms will be available on www.kepro.org. Most existing forms can be used and also submitted. In time, additional forms will be built into iEXCHANGE.
FAQ ID:
39
Answer: Handle this as a retro case; the policy has not changed.
FAQ ID:
40
Answer: It is desired to post in iEXCHANGE, but information can be faxed.
FAQ ID:
41
Answer: Start review process from that date as long as the recipient has an active Medicaid #
FAQ ID:
42
Answer: Submit this to KePRO with supporting information documenting reasons for not knowing status initially. This can either be documented in iEXCHANGE notes or faxed. We will work with DHMH to address on a case by case basis.
FAQ ID:
43
Answer: A level of care can be obtained by submitting the 3871 via iExchange or Fax. The 3871 is available on KePRO’s website to download. If a level of care is not obtained prior to the admission, a retrospective level of care will be provided for chronic. It is preferred that the information is submitted prior to admission so that an authorization can be generated.
FAQ ID:
44
Answer: Basically all information provided to the previous contractor during the onsite review will need to be available to KePRO staff. The forms remain the same. Any needed forms can be accessed via KePRO web at www.kepro.org; click the Hunt Valley, Maryland link.
FAQ ID:
45
Answer: The provider will notify KePRO that an Advisory level of care is needed. The 3871b should be faxed in or submitted through iExchange. There is a $30 fee for completing this process.
FAQ ID:
46
Answer: It will look similar but with a KePRO letterhead.
FAQ ID:
47
Answer: For NF levels, if scoring meets, it will have automatic approval. The reimbursement level of care will be faxed back either later that day or next business day. Chronic level of care and NF’s that require additional information will be reviewed once the additional information is available and is either approved or referred for Physician Advisor review. This time frame will vary.
FAQ ID:
48
Answer: DHMH transmittals are available on the DHMH website. The weighting tool that is used for ranking the 3871b is not available.
FAQ ID:
49
Answer: No, either pick the Long Term Care fax number or Acute (whichever is appropriate for your facility). You will be notified of determination via fax back.
FAQ ID:
50
Answer: Yes, KePRO is replacing Delmarva as the contractor for authorization for Maryland Medicaid Recipients.
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