Kepro is excited to announce that we have been selected by the Indiana Family and Social Services Administration (FSSA) as the new fee-for-service (FFS) prior authorization (PA) and utilization management (UM) vendor for the Indiana Health Coverage Programs (IHCP). Kepro uses InterQual® criteria along with State and Federal guidelines to help ensure clinically-appropriate medical utilization decisions.
Kepro will assume the PA-UM responsibilities beginning July 1, 2023. Kepro will take over PA, the Right Choices Program (RCP) and Traumatic Brain Injury (TBI) program responsibilities. Nonemergency transportation PA will continue to be managed by Verida. Gainwell Technologies will continue to manage claim processing. The pharmacy benefits manager, OptumRx, will continue to process pharmacy authorizations covered under the FFS pharmacy benefit. You can reach OptumRX or Verida portals by visiting the Portal Links for Providershere.
Recognized as the largest federally designated Quality Improvement Organization (QIO) in the nation, Kepro's reputation is a result of providing many years of innovative healthcare management solutions to multiple state Medicaid and Medicare programs, the Department of Defense's (DoD) national TRICARE program, and five of the nation's largest insurance providers.
Kepro is URAC accredited in Health Utilization Management and Case Management. We are also licensed to perform medical reviews in 29 states.