New Services Performed by KePRO, the Quality Improvement Organization (QIO) for S.C. Medicaid

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Effective August 1, 2012 the following will be added to the list of services that require prior authorization (PA) from KePRO.   

 

Durable Medical Equipment (DME)

 

All DME codes that are currently reviewed by SCDHHS will be submitted to KePRO for prior authorization.  Attachment A is a complete list of codes.  Unlisted or Miscellaneous DME codes that are submitted for the repair of equipment or accessories should only be submitted to KePRO if the original equipment was approved by KePRO on or after June 1, 2012.  If the original request was approved by SCDHHS prior to June 1, 2012, the repair will continue to be submitted to SCDHHS along with the Certificate of Repair and Labor Cost (CRLC).

 

Botulinum Toxin – Type A (Botox) and Type B (Myobloc)

 

KePro will prior authorize (PA) all Botulinum Toxin – Type A for Botox® and Type B (Myobloc) when administered for Food and Drug Administration (FDA) approved indications. Botox® is FDA-approved for strabismus, blepharospasm, severe primary axillary hyperhidrosis, upper limb spasticity in adults, cervical dystonia in adults and for the prophylaxis of headaches in adult patients with chronic migraine (>15 days per month with headache lasting 4 hours a day or longer).

 

The botulinum toxin products listed above share certain properties and some FDA approvals.  However, these agents are not identical.  They have differing therapeutic and adverse event profiles.  They also have differing units and not equivalent dosing.  As a result, they are not directly interchangeable with one another. Please refer to your provider manual for additional information regarding claims submission.

 

KePRO will post the applicable forms for requests for prior authorizations to their website.  Requests may be submitted using one of the options below:

 

KePRO Customer Service Phone:           855-326-5219

KePRO Fax #                                               855-300-0082

For Provider Issues email:             atrezzoissues@Kepro.com

 

Responses to requests will be faxed back to the provider with an approval or denial.  Please visit KePRO’s website at http://scdhhs.kepro.com for additional information about KePRO’s web based PA submission, upcoming trainings, forms and any new policies or procedural changes affecting Medicaid’s QIO process.

 

If you have any questions, comments or concerns regarding this bulletin, we encourage you to submit them to comments@scdhhs.gov.

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