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Quality Oversight & External Quality Review

KEPRO Quality Oversight elevates services and maximizes budgets.

Quality Oversight & External Quality Review

KEPRO provides an independent, impartial evaluation of the healthcare provided on behalf of the federal government. We apply our experience, expertise and advanced data mining to improve the quality of services system-wide. Then help find the absolute best value in healthcare. All with the most qualified peer reviewers dedicated to delivering surpassing services with measurable outcomes that benefit all parties. Then we get feedback from our clients to assure real world results.

Quality Improvement & External Quality Review

Helping States Monitor Their Managed Care Entities

To ensure that Medicaid recipients receive both high-quality and appropriate care, state Medicaid agencies are required to engage independent external quality review organizations (EQROs) to assess the performance of their managed-care entities.

Leveraging our extensive national experience and drawing upon our depth of clinical expertise, KEPRO helps states meet the EQRO requirement with comprehensive services that monitor quality of care, finances, encounter data, access and provider networks, and grievances, with the goal of:

  • Improving health outcomes
  • Increasing consumer satisfaction
  • Delivering care that is accessible, coordinated, and of high quality

KEPRO’s services include:

  • Information system capability assessments
  • Healthcare Effectiveness Data and Information Set (HEDIS) reviews and program analysis
  • Performance measure validations, improvement plan development, implementation and review
  • Ongoing training, education and technical assistance during and after reviews
  • Medical education interventions for facilities, physicians and other providers
  • Comprehensive data collection, analysis and reporting
  • Continuous quality improvement and outcomes management

Learn more about our Quality Oversight services and solutions.

Find an Answer

Please describe KEPRO data security that ensures member information is protected.

As an organization that is charged with storing and transferring Protected Health Information (PHI), KEPRO is bound by HIPAA regulations, and is accustomed to managing the security and privacy of PHI. KEPRO currently exchanges data successfully and confidentially via secure encrypted means in support of all of our federal, state, and local government programs, and with commercial clients.

KEPRO has been implementing and supporting systems that require medical record, data security, and transmission for more than a quarter of a century, and has always placed primary importance on using systems that allow for fast and efficient connectivity, while still providing the highest level of data and system security. Our proven internal and external policies and protocols ensure compliance with state and federal laws and regulations, as well as any additional security measures you may require.

We have a stringent KEPRO Comprehensive Confidentiality Plan that governs our processes. KEPRO’s Privacy Officer, Security Officer, and the Compliance Officer have ultimate responsibility for oversight of the processes and procedures contained in the KEPRO Comprehensive Confidentiality Plan.

KEPRO's system is secure. Our information systems are secured by an in-depth strategy that utilizes multiple layers of operational, management, and technical controls to protect KEPRO assets. We also employ software programs designed to prevent unauthorized use by staff or outside entities.

All KEPRO information systems employ common security controls such as Firewalls, Anti-virus, Role Based Access, FIPS 140-2 Encryption for mobile devices, and the requirement of strong passwords. Information system users are assigned a security role based upon access requirements relevant to their positions and information/program privileges.

The HIPAA Security Rule requires entities to implement information systems that control access to healthcare and related systems. KEPRO adopts a subset of NIST 800-53 Rev 3 Security controls to maintain compliance with HIPAA. Based on these security standards, KEPRO mitigates risk to its Information system by focusing on such controls as:

  • Log-In Security. HIPAA security requires the use of secure User IDs and the use of passwords. KEPRO requires multiple account authentication processes within its information systems to verify the identities of our end-users. KEPRO's policy requires strong passwords that are changed frequently.
  • Access Control. HIPAA requires one of the following: Context Based Access, Role Based Access, or User Based Access. User Based Access is part of the Log-In Security component. KEPRO's Role Based Access gives individual users access relevant to their function in the organization.
  • Audit Trail. HIPAA requires the use of an audit trail to identify who accesses PHI. KEPRO systems track those who change the patient record, the date and time the record was modified, and the specific information changed. The system includes a read only audit trail that captures each time a system user views a case.
  • Session Time-out. KEPRO information systems account for session inactivity by locking screens after 10 minutes of inactivity.
  • KEPRO's physical space is secure. KEPRO’s computer, telephone, and hardware systems are located in climate controlled rooms with fire-suppression and electronic locking system. We allow only authorized access to the room.
  • KEPRO focuses training on confidentiality and security issues. All KEPRO employees undergo rigorous training on security and confidentiality of PHI. We have successfully provided this training to all staff regardless of their respective roles/duties.

KEPRO Headquarters

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777 East Park Drive, Harrisburg, PA 17111
Toll-free: 800.222.0771
Phone: 717.564.8288
Fax: 717.564.3862