Provider information

KP’s Clinical Practice Guidelines (CPG) are developed through the KP National Guideline Program and subsequently operationalized at KPHI. CPGs are based on the best available clinical evidence. The KP National Guideline Committee reviews relevant evidence and authors each CPG. KPHI adopts or adapts these evidence-based guidelines and operationalizes these clinical recommendations considering the needs of KPHI’s membership. When implemented, these guidelines help to reduce unwarranted variation in care and improve clinical outcomes.

To ensure evidence-based recommendations, guidelines incorporate the following framework and tools:

• The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework is used to systematically evaluate the quality of a body of evidence and assign an appropriate strength to each recommendation.
• The AGREE (Appraisal of Guidelines Research and Evaluation) II tool is used to assess the methodological quality of existing clinical practice guidelines being considered for adoption into the NGP portfolio.
• The ROBIS (Risk of Bias in Systematic Reviews) tool is used to assess the methodological quality of existing systematic reviews being considered for use in answering clinical questions.

Affiliate providers may obtain a copy upon request by e-mailing hi.clinicallibrary@kp.org.

HR 133 No Surprises Act

Federal Mandate HR-133, No Surprises Act, is a statute that requires us to verify and update provider directory information for providers who participate in the Commercial line of business at least once every 90 days. Please ensure your email addresses are up to date. The email notifications are sent the 1st week of March, June, September, and December. Download form here.

For all other lines of business (excluding Commercial), send your demographic updates (NPI, Address, Phone Number, etc.) to ProviderDemographicsHawaii@kp.org.

Kaiser Permanente Hawaii maintains a Quality Improvement Program to evaluate the quality of care provided to members for continuous improvement. Each year, strategic clinical and service goals are established to help improve members’ health care. Information including members’ health status, care provided to members with certain chronic conditions, and the number of members receiving recommended preventive care can be obtained from the electronic medical record for regular evaluation of performance to make changes when necessary. Members are also surveyed on how they feel about the quality of care they receive to assist in determining when and how to improve care.

Since 1995, Kaiser Permanente Hawaii has been accredited by the National Committee for Quality Assurance (NCQA), an independent not-for-profit organization dedicated to measuring the quality of America’s health care. Accreditation is subject to renewal every three years.

Kaiser Permanente Hawaii also participates in a number of independent reports on quality of care and service so that members and the public have reliable information to better understand the quality of care delivered at Kaiser Permanente Hawaii, as well as a way to compare Kaiser Permanente Hawaii performance to other Hawaii health plans. Publicly reported performance data, including patient safety, are available at the following Web sites:

• NCQA Health Plan Report Cards
• NCQA Patient Centered Medical Home (PCMH) recognition of primary care clinicians and practices
• The Joint Commission hospital accreditation status and core performance measures
• Hospital Safety Grade
• Centers for Medicare & Medicaid Services hospital quality measurement data

Kaiser Permanente Hawaii has several disease management programs to assist you in managing your patients. These programs are designed to reinforce treatment plans for patients.

Additional information is available for download in Chapter 15 of the Affiliated Practitioner Manual.

Now you can search for physicians, departments, facilities, and more, all in one place. Just select your area and choose the way you prefer to search. You can even narrow your results to find exactly what you need. Get phone numbers and addresses at a glance, or visit doctor and location home pages for detailed information.

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• Provider Newsletters December 2019 
• Provider Newsletters April 2019

• National EDI Flyer 
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• Upload Provider Disputes and Other Electronic Attachments 
• Clinical Review Payment Determination Policy 
• Quality 

Learn how providers can register to receive ADT notifications per requirements of the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation.

• Admission, Discharge, and Transfer (ADT) Notifications (Kaiser Permanente) 
• Admission, Discharge, and Transfer (ADT) Notifications (Maui Health System)

 

The Kaiser Permanente Hawaii Affiliated Practitioner Manual is designed as a reference guide for you and your staff.

The manual may be viewed by your Admissions, Quality Assurance, Business Offices and any other appropriate staff.

Should you need additional information or have any questions, please do not hesitate to contact the Provider Contracting and Relations Department at (808) 432-5429.

The Provider Manual for HMO members may be viewed one section at a time. Click on the link below to open the PDF in a new window.

Introduction and Table of Contents

Section 1: Kaiser Permanente Medical Care Program
Section 2: Key Contacts
Section 3: Eligibility and Benefits Determination
Section 4: Member Rights and Responsibilities
Section 5: QUEST Integration
Section 6: Provider Dispute and Appeal Process
Section 7: Billing and Payment
Section 8: Utilization Management/Resource Stewardship
Section 9: Out-Of-Plan/Network Referrals
Section 10: Emergency and Urgent Care Services
Section 11: Authorizations and Referrals
Section 12: Quality Program and Patient Safety Program
Section 13: Compliance
Section 14: Practice Guidelines – Care Management and Disease Management
Section 15: Additional Information
Section 16: Kauai, Molokai, and Lanai Medical Services Network

The Kaiser Permanente Kauai Island Provider Playbook contains guidelines for you and your staff.

The Kaiser Permanente QUEST Provider Manual is designed as a reference guide for you and your staff.

The Provider Code of Conduct highlights some provisions in the provider agreement as well as the minimum standards by which providers are expected to conduct themselves when serving Kaiser Permanente members and patients.