Permanente Advantage provides pre-certification for medical services ONLY for Kaiser Permanente Insurance Company (KPIC) Point-of-Service (POS) and Preferred Provider PPO plan members. Permanente Advantage provides determination using evidence-based, nationally established criteria. As a URAC certified organization in Health Utilization Management (HUM), this exemplifies our commitment to high performance by embedding quality management principles into our daily operations. The certification process verifies and confirms our operational soundness, developed policies and procedures, set priorities, and identified organizational improvements.
Verification of pre-certification is required in advance prior to services being rendered, excluding emergency services. Pre-certification requests should be submitted by a healthcare provider. Any provider wishing to provide services listed under the individual member’s Certificate of Insurance (COI) is required to call, verify, and submit in advance a pre-certification request along with clinical information. You may submit your completed request form with supporting clinical documentation by fax or email to the following:
Fax #: 866-338-0266
Email: PermAdvantageTeam-KPPA@kp.org
Link to Permanente Advantage Pre-Certification Request Form.
If you would like a copy of the pre-certification requirements or have any questions about the pre-certification request form, the pre-certification process, or verification of services that require pre-certification, please email us at PermAdvantageTeam-KPPA@kp.org or call us at the appropriate phone number below.
- California Members: 1-888-251-7052
- Colorado Members: 1-888-525-1553
- Hawaii Members: 1-888-529-1553
- Mid-Atlantic Members: 1-888-567-6847
- Georgia Members: 1-855-265-0311
Failure to follow the pre-certification instructions may result in delay of processing your request or a denial of the request and possible non-payment for services, if rendered.
Providers and members can use the following links below to review the clinical criteria used in a denial determination or to access clinical criteria for potential future services.
MCG Health Transparency Link: MCG Transparency Portal - Login