CNSI subsidiary Keystone Peer Review Organization, LLC has won a $113 million contract with the Virginia Department of Medical Assistance Services to oversee utilization management, behavioral health utilization and case management services for those using Virginia’s Cardinal Care Medicaid program.
The contract has a 5-year base of work with five option years.
“We are grateful to the Department of Medical Assistance Services for recognizing our long-standing partnership providing high quality utilization management services and for extending this new opportunity to support its behavioral health services,” said Todd Stottlemyer, CNSI CEO.
“The commonwealth has long prioritized timely access to quality behavioral health services for its residents, and we look forward to supporting this important work.”
Kepro has been providing UM services for DMAS on the company’s proprietary Atrezzo care management platform for 16 years.
“This award reflects the dedication and deep expertise of our clinicians who have been proudly representing the Virginia Medicaid program since 2006, and we are honored to continue serving its program beneficiaries,” Meghan Harris, president and chief operations officer.
Under the contract, Kepro will manage service authorizations for inpatient and outpatient medical and behavioral health services in Cardinal Care’s fee-for-service program. The company will also service authorizations for Medicaid waivers, non-traditional level of care services and specialty services.
“Kepro has been an important partner in delivering utilization management services to fee-for-service Medicaid beneficiaries,” said Patricia Arevalo, Program Operations Division/Service Authorization Unit manager, Service Authorization at DMAS.
This new work will also include service authorizations of residential treatment for children and adults and for community mental health rehabilitation; as well as provision of call center services for providers and members, a behavioral health crisis line and care coordination for medical and behavioral health services.
“We look forward to continuing that relationship and upholding our commitment to provide equitable access to vital healthcare services for all Virginians,” Arevalo said.