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Learn about our authorizations policies, including process and procedures, denials, and appeals.
Learn about our medical coverage policies - referral guidelines for providers.
Download a list of services that require pre-certification for members under the Kaiser Permanente Flexible Choice™ and Out-of-Area PPO plans.
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Authorizations policies
Download our authorization policies* to learn more about our utilization management and authorizations process, including:
- the role of the Provider Service Center, our centralized authorization and referral department
- referral policies and procedures
- hospital and facility admissions
- case management
- denials and appeals
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Medical coverage policies
We provide medical coverage policies - referral guidelines as a reference for health care professionals within the Kaiser Permanente Medical Care Program. The Kaiser Permanente Mid-Atlantic States medical coverage policies may provide details about referring patients for treatment, including the following:
- diagnosis
- indications
- contraindications
- measures prior to referral
- clinical indications for referral
- optional approaches
If you would like to receive a hard copy of the Medical Coverage Policy, UM criteria/protocol or Affirmation Statement, please contact the Utilization Management Operations Center at 1-800-810-4766 and follow the prompts.
Permanente Advantage
Permanente Advantage provides pre-certification of benefits for the Flexible Choice™ (PPO & Indemnity Tiers) and Out-of-Area PPO plans.
Download a list of services that require pre-certification:
Flexible Choice™
- Maryland♦
- District of Columbia♦
- Virginia♦
Out-of-Area PPO
- Maryland♦
- District of Columbia♦
- Virginia♦
Providers may request pre-certification by either:
- Calling Permanente Advantage at 1-888-567-6847; or
- Completing the Permanente Advantage Pre-Certification Request Form♦ and faxing to 1-866-338-0266
For Maryland providers serving Maryland-based employers, you may also request a pre-certification tracking number at:
MarylandProviderRequests@kponcall.com
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