​Kepro Behavioral Health Authorizations and Early and Periodic Screening, Diagnostic, and Treatments (EPSDT) Services Awareness​

Apr 24, 2023

Kepro reviews clinical documentation submitted with Prior Authorization (PA) and Continued Stay Review (CSR) requests for members under 21 years of age, including requests for behavioral health services. Kepro reviews the documentation for medical necessity of the requested services not only under the service-specific limits of the MaineCare Benefits Manual (MBM), but also under EPSDT guidelines.     

Behavioral Health providers should be aware that, for MaineCare members under 21 years of age, if a PA or CSR is not granted due to limits/frequency under MaineCare guidelines, Kepro will automatically review the request under EPSDT guidelines.     

Providers must use the EP modifier when billing MaineCare for claims when Kepro has approved services under MaineCare Benefits Manual, Ch. II, Section 94, EPSDT Services. You should check the provider’s download notification report to view if a request has been approved via EPSDT. The request will also include a note stating that the PA or CSR was granted under the EPSDT program, found under the communications tab in Atrezzo.     

Please ensure you check these authorizations and include the EP modifier on your claims submitted to MaineCare. The EP modifier will be the last modifier listed on your claim line.    

For EPSDT questions, please email the MaineCare EPSDT Coordinator, Tia Bolduc, at: DHHS.EPSDT@Maine.gov.   

For questions on Atrezzo portal submissions, please email Kepro Provider Relations at: ProviderRelationsME@kepro.com.