Please select from our recently updated templates below and send completed information to KPCO-PDM@kp.org.
Please note: CONTACT UPDATES can be made in any template below.
- Use Practitioner Adds-Changes-Terms Template for:
- Add new practitioner to existing location
(see Combined new Practitioner and New Office template for adding to a new location) - Change current practitioner demographics
- Term practitioner from group
- Add new practitioner to existing location
- Use Service and Billing Office Adds-Changes-Terms Template for:
- Add and/or term locations
- Includes location moves and/or TIN-NPI updates
- Change location details i.e. phone and fax
- Change remittance address ** for noncontracted providers please see below
- Use Combined New Practitioner and New Office OR Combined New Practitioner and New Office (PPO Only) for:
- New Practitioners being added to new locations
- New Agreements
- Includes organization changes
- For Voluntary Provider/Front Office Demographic Reporting Template
Voluntary Provider/Front Office Demographic Reporting Template
**For a KPCO noncontracted provider claims billing/remit address update
Please send the W9 to:
Kaiser Permanente of Colorado
Claims Administration
P.O. Box 373150
Denver, CO 80237