Changes to Administrative Review Procedures of Select Physician Administered Drugs

Effective March 1, 2020, the South Carolina Department of Health and Human Services (SCDHHS) will implement the changes described below for select physician-administered drugs.

SCDHHS contracts with a designated quality improvement organization, KEPRO, for utilization review and prior authorization services. Providers serving Medicaid fee-for-service beneficiaries must receive prior authorization from KEPRO for the following limited list of physician-administered drugs:

For treatment requests, the Administrative Medication Review (AMR) Authorization Form must be submitted to KEPRO, via fax at (855) 300-0082 and must include supporting medical documentation in order for providers to receive Medicaid reimbursement. Authorization or denial to utilize the physician-administered drug will then be determined with the final deliberation communicated to the provider by KEPRO. Failure to obtain approval prior to the provision of services may result in a claim denial.

A copy of the AMR Authorization Form is included with this bulletin and may be found at https://scdhhs.kepro.com/content/forms.

Questions regarding this authorization process can be directed to KEPRO at 855-326-5219. Providers with other questions regarding this bulletin should contact the SCDHHS provider service center at 888-289-0709.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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