Additional Services Performed by KePRO

Effective with dates of service on or after January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will require prior authorization (PA) for Inpatient Psychiatric Services for Children Under 21 from our Quality Improvement Organization (QIO), KePRO.  PA requests must meet the requirements for Certification of Need (CON) for Children Under 21 admitted for psychiatric services.

For Medicaid beneficiaries who need placement in a Psychiatric Residential Treatment Facility (PRTF) or Inpatient Psychiatric Hospital Services for Children Under 21, the referring state agency must provide the admitting PRTF or Inpatient Psychiatric Hospital with the required documentation for authorization of the placement. This includes the Inpatient Psychiatric Residential Services Authorization Form 257 and required clinical documentation to support placement.  Upon receipt of this information, the admitting provider must submit the request for prior authorization along with required medical documentation to KePRO.  KePRO will use Interqual Behavioral Health criteria supplemented by SCDHHS policy to approve or deny the admission.  Unless indicated through policy, all requests for approvals and denials will be reported to the provider via fax within two business days.  Upon receipt of the PA from KePRO, the admitting provider will need to share the determination with the referring state agency.  Current SCDHHS policy can be reviewed at in the Psychiatric Hospital Services Provider manual.

For current PAs issued by a referring state agency that include dates of service on or after January 1, 2013, a new KePRO PA will be required in order for the services to remain covered by SCDHHS.  Providers must submit their current Form 257 and supporting documentation for the continued stay to KePRO.  KePRO will issue a new PA for the remainder of the stay.

All applicable forms for requests for prior authorizations will be posted to KePRO’s website. Also posted are upcoming trainings, new policies or procedural changes affecting Medicaid’s QIO process and direct links to Medicaid policy manuals.             KePRO will be conducting web based training sessions for providers of Inpatient Psychiatric Services for Children Under 21 over the next few weeks.  Please visit the web site for training dates and times at If you have questions or concerns with the above process, please contact KePRO at the following:


KePRO Customer Service Phone:                                   855-326-5219

KePRO Fax #:                                                                      855-300-0082

For Provider Issues email:                           

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