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Clinical review
For information concerning whether a specific service or benefit is covered, please refer to your Evidence of Coverage, or call Kaiser Permanente Member Services at 303-338-4545 or toll-free at 1-800-218-1059 (TTY 711).
Please tell us your location so we can take you to information customized for that area.
The document below is available to detail the review process and procedures:
- Utilization Management
- Durable Medical Equipment (DME)
- Kaiser Permanente also utilizes externally developed clinical criteria. Those documents can be reviewed on:
- KPCO PPO Authorization/Denial Report 2025 Report