Acentra Health (Acentra), formerly known as Keystone Peer Review Organization, Inc. (Kepro) is the medical management administrator for the Plan. Acentra provides medical management, case management and utilization review services. Utilization review is a process to ensure medical services are medically necessary, delivered in the most appropriate setting, reflective of the correct length of stay, and consistent with generally accepted medical standards. Certification requirements may apply, regardless of whether a participant uses a network or out-of-network provider.
Certification is not required for those participants having Medicare for their primary coverage or other primary coverage, unless the primary carrier does not cover the service. For additional information on services requiring certification, participants can reference the Medical Case Management and Utilization Review section of the Plan Document or access the information on the Plan's website at https://www.dfa.ms.gov/insurance.