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KEPRO Ohio Medicaid

KEPRO is collaborating with the Ohio Department of Medicaid (ODM) to provide quality and utilization reviews for health coverage claims and retrospective reviews for 3 million Ohioans. We collaborate with Ohio’s network of approximately 90,000 providers to ensure that Ohio Medicaid recipients receive the right care, at the right time and in the right setting.

KEPRO provides prior authorization and precertification reviews, retrospective reviews, medical necessity, billing and quality care reviews. KEPRO may also provide special reviews for medical surgery, behavioral health reviews and prior authorization.

In addition, KEPRO will be conducting health studies for the development of quality improvement projects to enhance the services and care Ohioans receive.