The purpose of this announcement is to notify providers that certain services currently reviewed by DMAS’ Medical Support Unit (MSU) will be reviewed by Keystone Peer Review Organization (KePRO), DMAS’ service authorization contractor. KePRO will begin accepting requests, regardless of the dates of service, on April 1, 2012. KePRO will provide web based training sessions for providers starting March 23, 2012. Providers may access these training sessions by going to http://dmas.kepro.com and clicking on the Training tab.

New Procedure Codes That Will Require Service Authorization, Beginning April 1, 2012
Effective April 1, 2012 the procedure codes on the spreadsheet attached to the Memo, marked with an asterisk and bolded, will require service authorization prior to claims submission to obtain payment for services. There is no retroactive authorization period for these services, except for retroactive eligibility determination. These codes require service authorization effective April 1, 2012 prior to rendering services. The only instance KePRO will approve services retroactively on and after April 1, 2012 for these new codes requiring service authorization is when the provider demonstrates retroactive Medicaid eligibility determination for members.

KePRO will allow retroactive reviews for service requests submitted through June 30, 2012 only for the procedure codes attached to DMAS Medicaid Memo dated 3/9/2012. Effective July 1, 2012 KePRO will not authorize requests retroactively for these procedure codes, regardless of the dates of service. The only instance KePRO will approve services retroactively on and after July 1, 2012 is when the provider demonstrates retroactive Medicaid eligibility determination for members. Provider Manuals will be updated and posted on DMAS and KePRO websites. There will be a new Fax Form for Transplants-DMAS 351 and the DMAS 363 Outpatient Fax Form has been updated.


NOTE: DMAS 363 Outpatient Fax Form and DMAS 351 have been revised following the 3/9/2012 Memo posting. To access the current version, click on the Forms tab, on this page, and navigate to OP DMAS 363 or the new Transplant DMAS 351.