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KEPRO Extends Use of InterQual to Support Clinical Excellence in Utilization and Quality Reviews
[January 25, 2016]

KEPRO Extends Use of InterQual to Support Clinical Excellence in Utilization and Quality Reviews

KEPRO (Keystone Peer Review Organization, Inc.) has signed a long-term agreement to continue its use of InterQual® for utilization and quality review across its state Medicaid contracts, Medicare reviews, and other commercial lines. Specifically, KEPRO has renewed its license for all of the InterQual Level of Care, Behavioral Health, and Care Planning Criteria.

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KEPRO will utilize InterQual evidence-based clinical criteria exclusively for review of two-midnight short stays on behalf of the Centers for Medicare & Medicaid Services (CMS). KEPRO is one of only two Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs) charged by CMS to audit short stay claims. KEPRO is the BFCC-QIO for the more than 30 states within CMS Areas 2, 3 and 4.

In all its service areas, KEPRO helps identify and coordinate the appropriate care for clients and their members and beneficiaries with acute, chronic and complex conditions across the healthcare continuum. KEPRO is URAC-accredited in case management, health utilization management, and disease management.

InterQual evidence-based criteria help improve clinical decision-making across the medical and behavioral health continuums of care. The InterQual clinical development team synthesizes the most current, best evidence into a fully referenced decision support tool that is reviewed and updated annually. InterQual's development process, honed over nearly 40 years, is founded on rigorous review of the literature, and includes extensive peer review by practicing clinical experts across the United States.

For more information on McKesson Health Solutions, please visit our website, hear from our experts at MHSdialogue, and follow us on Twitter (News - Alert) at @McKesson_MHS.

Recent McKesson Health Solutions News

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McKesson InterQual® 2015 Sets New Standard for Peer-Reviewed Evidence-Based Clinical Content
Over 600 Payers, Providers Chose McKesson InterQual® Criteria for Clinical Decision Support


KEPRO, a leading quality improvement and care management organization, offers innovative and outcomes-focused solutions to reduce the utilization of health care resources and optimize quality of care for public and commercial clients. KEPRO's comprehensive, member centric care management solutions go far beyond traditional utilization and case management by coordinating the care provided to members with acute, chronic and complex conditions across the continuum, and identifying members who are at the highest risk for future services, but have not yet had an acute event. Tailored programs maximize members' quality of life, and realize greater cost savings for members and clients. For more information about KEPRO or the BFCC-QIO, visit

About McKesson Corporation

McKesson Corporation, currently ranked 11th on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. McKesson partners with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers improve their financial, operational, and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services. For more information, visit

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