1. Review the below request type definitions to determine the most appropriate selection:
- Prior Authorization – the service(s) or item(s) have not been provided yet. This request is to seek prior approval.
- Retrospective – the service(s) or item(s) have already been rendered prior to requesting for authorization.
- Reconsideration – this form of request is submitted following a medical necessity/Medical director denial. The denial letter received via MN-ITs has details on how to submit reconsideration requests to Kepro (please note, Kepro does not handle appeals). This request should be received within 20 working days of the date of the denial.
2. Review Timeframe
- Kepro has up to 10 business days to take initial action (approve, deny, or pend for additional information) on a prospective authorization request.
- Kepro has up to 20 business days to take initial action (approve, deny, or pend for additional information) on retrospective and reconsideration requests.
- change requests will be processed within 20 business days
- If a request is pended for additional information needed, providers have up to 15 calendar days to return all requested information. Failure to respond may result in denial and require a new Authorization to restart the process with all documentation necessary to make a determination.
- Verify eligibility and Authorization Requests and Medicare or Third-Party Liability (TPL) Coverage prior to submitting requests.
** For additional information on authorization requirements refer to the below MHCP Provider Manual link**