KEPRO is the Defense Health Agency’s (DHA) TRICARE Quality Monitoring Contractor (TQMC) by the Department of Defense, TRICARE Monitoring Activity.
As a part of the TRICARE’s Quality and Utilization Review Peer Review Organization Program, and in accordance with the Code of Federal Regulations (CFR) 32 CFR 199.15, the TMA has established the following contractual objectives for the TQMC:
- To provide an independent, impartial evaluation of the health care provided to the MHS beneficiaries.
- To evaluate “best value health care” as defined in the TRICARE Operations Manual.
- To measure, evaluate, and identify superior quality health care services and recommend means to transfer successes.
- To provide comprehensive and timely reviews that are consistent with all TRICARE requirements, reflecting high quality work for all work assigned, including mental health facility certification, peer review for TMA, reconsideration reviews, and Standard of Care determinations for Military Treatment Facility (MTF) malpractice cases.
TQMC Primary Responsibilities
- Retrospective Chart Review for Quality of Care
- External Reviews for DHA Appeals, Hearings and Claims Collections Division
- Medical Necessity (Reconsideration) Appeals
- Military Treatment Facility Standard of Care Peer Reviews
- Mental Health Facility Certifications
- Focused Studies
- Technology Assessments