All practitioners applying for initial or continuing participation with us are required to complete an application with attestation that the information provided is accurate. We will access your web-based application and attestation via CAQH ProView™ if you are currently enrolled in this web-based program. If you are not enrolled in CAQH ProView™, the Kaiser Permanente Credentialing Department will continue to request paper copy applications. Reminder letters requesting re-credentialing applications will continue to be mailed 3 months prior to credentialing expiration. However, we encourage you to take advantage of the secure web-based CAQH ProView™ program to eliminate the time-consuming paper copy application process.

As a reminder for practitioners enrolled in CAQH ProView™, an application with attestation is due for renewal every 120 days. If the application is not current when the Kaiser Permanente Credentialing Department accesses the documentation, staff will contact you or your practice manager to update/re-attest. If the attestation in CAQH Proview™ is not updated within 15 days of the request, Credentialing staff will request a paper copy application within 7 days.

Credentialing decisions are based upon the information provided in the complete application with attestation, primary source verification of education, license, DEA, Medicare/Medicaid billing status and any reported quality/service occurrences.

You have the right to:

- be informed of the status of your application.
- review any information we obtained to make a credentialing determination.
- correct erroneous information utilized to make a credentialing determination.

Please notify us when new practitioners join your group practice by contacting your provider relations representative directly, or by calling us at 877-465-0029 (toll-free). You may also email us at GA.Provider-relations@kp.org.

Labs

Lab Requisition form

Pharmacy

Application to add new drugs

Complete an application to add new drugs and the disclosure form to request that a new drug be added to the formulary.

Disclosure Form

Non-formulary Prescription Overview Form

Non-formulary Prescription Form

Radiology

Radiology Imaging Order form

For members

Authorization to release or obtain PHI

Members may use this authorization form to give permission for Kaiser Permanente to obtain or release protected health information.

Advance directives for health care form

Members may complete this form to designate a health care agent and a back-up health care agent, to indicate treatment preferences, and to nominate a person to be their guardian.