CalMHSA

FAQs

This section helps guides hospitals and community health plans with short answers to frequently asked questions.

    Frequently Asked Questions

    Frequently Asked Questions

    • What part of the concurrent review process will Kepro cover?

    The concurrent review process begins when the hospital enters a Medi-Cal beneficiary into the Atrezzo system. Kepro will provide the clinical review for medical necessity criteria authorization and submission of the TAR, quality review, and appeals representation.

    • Will Kepro clinically review my request over the weekend?

    Yes, Kepro is required to clinically review all concurrent requests within 24 hours, including weekends.

    • How do the counties contact Kepro is there is a problem that needs to be addressed?

    Kepro will be actively engaged and communicating with the counties on a routine basis. There are several options for communication including a group email address. Kepro has hired a Customer Service Representative who will be available during normal business hours to answer questions and to provide technical assistance. Kepro will provide the counties and hospitals with an escalation tree shall a problem arise. If there is an issue that cannot be properly handled between the counties and Kepro, we will escalate the issue to CalMHSA for support. Kepro will conduct regular meetings with the counties on a quarterly basis. Kepro also plans on developing a Quarterly Stakeholder Advisory Council with representation from each of the counties to discuss the ongoing issues and concerns. During these meetings, information on what is working well and what needs to be improved will be discussed.

    • How can I contact a Kepro clinical reviewer?

    Kepro's Atrezzo portal allows for two way communication between you and the clinical reviewer. For instructions on how to send Kepro a message, view page 12 of our Atrezzo Portal Guide.

    • Will Kepro communicate with our Hospital Liaison/county staff in charge of supporting and tracking hospital discharges?

    Yes, Kepro staff will outreach to the hospital liaison/county staff members if there are questions about discharge planning or administrative days.

    • Will counties be receiving notification of admission from the hospital and will/how will that notification be communicated?

    Kepro will receive notification via the Atrezzo system. Counties will have access to Atrezzo and can generate reports through the Atrezzo system. Reports can be distributed daily, weekly, or monthly or generated by the county on an as needed basis.

    • Do I need to submit a request for a beneficiary that is not Medi-Cal eligible?

    Yes, Kepro will be reviewing all inpatient psychiatric hospital admissions.

    • How will our county know what days were approved vs. not?

    All outcomes are documented within the Atrezzo portal. Kepro can develop a report within the Atrezzo platform that provide the outcome of all case submissions. This can be scheduled to be sent securely to county contacts. Reports can be distributed daily, weekly, or monthly.

    • How do we view the client’s hospital documents (progress notes, admit/discharge notes, treatment plan, etc.)?

    Kepro, Counties and Hospitals will all have access to login to the Atrezzo system to view all uploaded documents and clinical information from the hospitals. Hospitals must upload documents into the Atrezzo system for review.

    • How will Kepro manage out of state hospitalizations (more common for counties that border other states)? Answer: CalMHSA is working with DHCS on this, but the Atrezzo system can accept a fax from the out of state hospital.

    Answer: CalMHSA is working with DHCS on this, but the Atrezzo system can accept a fax from the out of state hospital.

    • I'm curious about Kepro's knowledge of Presumptive Transfer/county of responsibility.

    Kepro is working with CalMHSA to get a clear understanding of the process and will make sure access to the state eligibility system. Kepro is still working through the details

    • Are there any statistics on the level of compliance/approval rates?

    Kepro will receive all state/CalMHSA polices and ensure the system will match those policies. Kepro uses Interqual on our reviews and will make sure differences for each county will be accounted for.

    • A couple times a year, we get a TAR for individuals who are Medi-Cal beneficiaries of other counties. Will Kepro be checking Medi-Cal eligibility and ensuring the proper county is billed?

    Yes, Kepro will ensure Medi-Cal eligibility and ensure proper county is billed. Counties will need to upload their MMEF file to a drop box at CalMHSA

    • Does Kepro also submit the TAR to the state fiscal intermediary?

    Kepro will submit the TAR to the fiscal intermediary. If the TAR is from a Short-Doyle Hospital, Kepro will send the TAR to the County.

    • Will there be an opportunity for counties to provide feedback on the determination of county of responsibility?

    Yes. If Kepro is ever unsure of county of responsibility, outreach to the county will occur immediately. However, Kepro will follow the guidance outlined in the DHCS Information Notice 21-072, County of Responsibility for Specialty Mental Health Services and Arbitration between Mental Health Plans.

    • What does the Kepro discharge planning and coordination look like?

    Questionnaires, anything uploaded, and notes will be available to counties.

    • Can a county initiate the need for review by entering into your system?

    Yes, the county could enter a request. Access for county could be set similarly to hospital.

    • Are NOABDs available in the threshold languages?

    Yes, they will be available in threshold languages. Kepro will be mailing them out.

    • Occasionally the stay is split between 2 counties, can Kepro's process accommodate that?

    Yes. Kepro would need to determine how it would be entered/worked out in the Atrezzo system. Admission would likely have to be split in the system to reflect proper county of responsibility.

    • Will Kepro conduct a concurrent review if it a private insurance company paying for the hospitalization?

    No, Kepro will only conduct a concurrent review for Medi-Cal beneficiaries.

    • We have a county owned PHF that is contracted to a vendor to operate. We do concurrent review with them, but they don't bill us through TARs but rather via a monthly invoice based on the number of beds in the facility. Will that be a county-specific process you discuss with the county since the process may not match other counties? (the bed days are paid regardless)

    Kepro will take this question back and talk through the workflow.