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Hot Topics


Changes to Vestibular Test Codes

Changes to CPT codes have been made to codes used for Vestibular Testing. The new codes can be found under the Provider Tab, "All CPT codes in numerical order" document. Please review these codes prior to submitting your requests to be sure you are using the correct CPT codes for your prior authorization as well as your claims submission.

Posted: 4/7/2017

Changes to PT and OT Codes

Changes to CPT codes have been made to codes used for Physical and Occupational Therapy Evaluations and Re-evaluations. The new codes can be found under the Provider Tab, "All CPT codes in numerical order" document. Please review these codes prior to submitting your PT or OT requests to be sure you are using the correct CPT codes for your prior authorization as well as your claims submission.


Posted: 2/7/2017

Changes to Dental and Oral Surgery CPT Code Lists

Changes to CPT codes have been made to both the General Dental and Supplemental Dental and Oral Surgery CPT code lists. Please review these lists prior to submitting your Dental or Oral Surgery requests to be sure you are using the correct CPT codes for your prior authorization as well as your claims submission.

Posted: 2/2/2017

Moffitt Announcement and Referral Processing

Entering a referral to a Moffitt Cancer Specialist

Referral to a Specialist-follow the usual steps when entering a referral:

 

When searching for the servicing/specialist physician for the member to seen at Moffitt Cancer Center, conduct a provider search using NPI or Name. When the search results display- select the physician with the address listed as ‘MOFFITT CANCER CENTER’-

 

**Examples are provided under the tab” Providers”- tab- Moffitt Dx codes- Document named Moffitt Announcement and Referral Processing ***

 



Posted: 12/9/2016

Moffitt Announcement and Referral Processing

The Hillsborough County Health Care Plan has contracted with Moffitt Hospital to provide needed cancer services for our clients. Effective December 9, 2016 Moffitt Hospital will be providing the following hospital-based inpatient and outpatient medical services to HCHCP clients:

 

·         Inclusive inpatient hospital stays, outpatient surgery services, diagnostic services, including but not limited to radiology and laboratory services, observation, and all hospital-based professional services.

 

·         Chemotherapy and radiation therapy.

 

Hospital and Physician Medical Services will be provided for the following diagnoses:

 

1. Neuroendocrine cancer

2. Sarcoma

3. Endocrine cancers

4. Acute Leukemias

5. Triple Negative Breast Cancer

6. Mesothelioma

 

The list of approved diagnosis codes are listed on the KEPRO website under the tab ‘Providers’ – tab – ‘Moffitt Dx Codes’. 

 

KEPRO conducts medical necessity reviews on behalf of the County.  Only certain CPT codes require prior authorization from KEPRO. The list of CPT codes can be found at http://hchcp.kepro.com/content/providers.aspx

 

 

**Examples are provided under the tab” Providers”- tab- Moffitt Dx codes- Document named Moffitt Announcement and Referral Processing ***

 



Posted: 12/9/2016

Announcements


Updated General and Supplemental Dental and Oral Surgery CPT Codes

Changes to CPT codes have been made to both the General Dental and Supplemental Dental and Oral Surgery CPT code lists. Please review these lists prior to submitting your Dental or Oral Surgery requests to be sure you are using the correct CPT codes for your prior authorization as well as your claims submission.

Posted: 2/2/2017


Keystone Peer Review Organization, Inc. (KEPRO), an industry leader in providing innovative, value-added healthcare management solutions, has been awarded the "Medical Management and Services" contract through Hillsborough County's Health and Social Services. The Hillsborough County (HCHCP) contract ensures appropriate, quality-driven care through quality improvement of specified inpatient hospital, medical and surgical services.

Recognized as the largest federally designated Quality Improvement Organization (QIO) in the nation, KEPRO's reputation is a result of providing many years of innovative healthcare management solutions to multiple state Medicaid and Medicare programs, the Department of Defense's (DoD) national TRICARE program, and 5 of the nation's largest insurance providers.

The Internet based system uses InterQual criteria to safeguard against unnecessary or inappropriate use of Medicaid services and provides clients with an enhanced secure system to perform accurate, confidential medical record review through a remote-user, virtual private network.


KEPRO is URAC accredited in Health Utilization Management, Disease Management and Case Management. We are also licensed to perform medical reviews in 29 states.

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