Sign out
In accordance with the Federal Consolidated Appropriations Act Section 5123, all QUEST providers are required to verify their provider directory data every 365 days. Please submit your information via the CAA Section 5123 Form Here
QUEST
At Kaiser Permanente, we believe in total health. Our KP QUEST program launched on January 1, 2015, brings our eligible members additional services to improve their overall health and well-being.
As a provider of services to our members, you are a critical part of our extended care team. You help our Members live healthier lives.
We want to make our providers’ transition to our new QUEST plan as simple as possible. That means you can continue to contact the same KP Partners you do today. For any operational inquiries related to QUEST, please call 808-432-5330 (Oahu) or Toll Free at 1-800-651-2237.
If you have any other questions or concerns, please call our Customer Service Center Department at 808-432-5330 (Oahu) or Toll Free at 1-800-651-2237, (1-877-447-5990 TTY hearing/speech impaired), Monday-Friday, 7:45 a.m. to 5 p.m. or Saturday, 8 a.m. to noon.
We encourage you to utilize our Online Affiliate tool which provides self-service capabilities such as:
- Verifying member eligibility, demographics and benefits
- Referral authorization inquiry and referral request
- Access to certain member chart information
- Request access to Online Affiliate.
For updates to your demographic information (NPI, Address, Phone Number, etc.), please send your updates to ProviderDemographicsHawaii@kp.org.
We thank you for your participation and look forward to working with you.
| Med-QUEST HOKU Registration | Credentialing | KP Online Affiliate | Claims Electronic Submission |
| STEP 1: All new Medicaid providers are required to register and enroll with HOKU to obtain a Medicaid ID # | STEP 1: If you are a new Medicaid provider, you will need to complete the Provider Credentialing packet that will be emailed to you from the Credentialing department | STEP 1: With KP Online Affiliate, you can view member eligibility and benefits, referrals and authorizations, claim status, and file provider disputes and appeals online. | Office Ally is a full service clearinghouse offering web-based service of submitting claims to Kaiser for FREE. Allows you to create CMS1500 claims on its website or use your existing software to create and submit claims electronically. 24/7 access from anywhere with internet connection, is convenient, secure and HIPAA compliant |
| STEP 2: Existing Medicaid providers must register with HOKU to remain Medicaid Providers | STEP 2: If you are an existing Medicaid provider, you will need to be recredentailed by Kaiser. Kaiser's credentialng department will reaching out to you via email. | STEP 2: Register by typing http://providers. kaiserpermanente.org/ into the address line of your internet. This will take you to Kaiser's Community Provider Portal (CPP) | STEP 1: You are able to enroll into Office Ally if you have submitted 1 or more paper claims to Kaiser
|
| STEP 3: In the CPP, a Provider Entity Agreement needs to be completed and returned | For more Information see section on Provider Tools | ||
| STEP 4: Complete the questions in the registration section and submit for approval | |||
| STEP 5: Once approved as a new user, you will receive an email containing your USER ID (NUID) | |||
| For more Information see section on Provider Tools |
Prior Authorization:
Call the Kaiser QUEST Service Coordinator at (808) 432-5330 or 1-800-651-2237
Fax: (808) 432-5260.
Referral Process is used for medical related services:
Kaiser Authorization Department for Plan Referral Phone at:
Phone: (808) 432- 5687, Fax: (808) 432-5691
Alt Fax: (808) 432-5667
A QUEST (Medicaid) overpayment is a payment that exceeds the allowed payment for services specified in the QUEST contract.
Overpayments may occur when a service is submitted under an incorrect patient’s name or member number, another insurance payor is identified, incorrect services are reported, or any payments received in error.
If you discover that you have received an overpayment, you must notify us in writing of the reason for the overpayment and return the overpaid amount to us within 60 calendar days after identifying the overpayment as follows:
- Include a copy of the Explanation of Payment (EOP) for each overpayment and highlight the overpaid amount.
- Enclose a check payable to Kaiser Foundation Health Plan in the amount of the overpayment.
- Provide the following information itemized for each member:
- Reason for the overpayment refund
- Date overpayment was identified
- Patient name
- QUEST member number and Medical Record Number (MRN)
- Claim number
- Date of service
- Date of payment
- Overpayment amount
Mail the EOP, check and itemized information to:
Kaiser Foundation Health Plan
Attention: Hawaii Regional Claims Recovery P.O. Box 745820
Los Angeles, CA 90074-5820
Kaiser Permanente Hawaii Region’s mission is to provide high quality affordable health care services and to improve the health of our members and the communities we serve.
Delivering on this mission includes providing care in a culturally competent manner to all members including those with limited English proficiency and diverse cultural and ethnic backgrounds, disabilities, and regardless of gender, sexual orientation or gender identity.
Kaiser members have the right to receive information in a language and manner that can be easily understood. Communicating effectively with limited English speaking patients or non-English speaking patients plays a large role in ensuring the quality of and compliance with care provided to members.
The Kaiser Permanente Hawaii Region’s Cultural Competency Plan is available to providers upon request at no charge.
Claims Customer Service
Contact Claims Customer Service for general claims information and billing questions, claim payment status, claims submission.
Monday – Friday 8:00 am – 4:30 pm
Oahu: 808-432-5330
Toll Free : 1-800-651-2237
Fax: 1-808-432-5433
Customer Service
Contact Customer Service for general eligibility questions and benefit verification.
Monday – Friday 7:45 am – 5:00 pm
Saturday – 8 am – 12 pm
Oahu 1-808-432-5330
Toll Free 1-800-651-2237
Hearing or Speech Impaired Toll Free:1-877-447-5990 (TTY)
Fax: 1-808-432-5300
Emergency Hotline
For emergency transfers to Kaiser Permanente Moanalua Medical Center & routine transfers after clinic hours:
(808)-643-6364
24 hours
QUEST Service Coordinator
Phone: 808-432-5330 (Oahu) or 1-800-651-2237 (Toll Free)
Fax: 1-808-432-5260
Manuals
The Kaiser Permanente QUEST Provider Manual is designed as a reference guide for you and your staff.
Newsletters
We are providing training sessions through WebEx, group trainings, and in-person education and training sessions to all contracted Kaiser Permanente Providers. Please review the training calendar for dates, times and locations. If you are interested in attending a training session or have a question regarding the calendar, please refer to the Contact List.
Code of Ethical Conduct - Kaiser Permanentes Principles of Responsibility
Compliance with Deficit Reduction Act Requirements Policy
Electronic Visit Verification – Provider Welcome Letter
Electronic Visit Verification – HCPCS Codes & Modifiers Lists
Fraud, Waste, and Abuse Control Policy
HHS Announces Enhanced Provider Portal Relief Fund Payments
Member Grievances and Appeals Quick Reference Guide*
Member Rights and Responsibilities Quick Reference Guide*
Prevention Detection and Reporting Fraud, Waste, and Abuse (FWA)
Prior Authorization Quick Reference Guide*
Provider Claims Submission Quick Reference Guide*
Provider Education & Training: Clinical Providers/MDs
QUEST Provider Education and Training Handout*
Webcast HRSA COVID 19 Medicaid and CHIP Program
Monthly Provider Trainings are held every second Thursday of each month |
|
|---|---|
| February 13, 2025 | August 14, 2025 |
| March 13, 2025 | September 11, 2025 |
| April 10, 2025 | October 9, 2025 |
| May 8, 2025 | November 13, 2025 |
| June 12, 2025 | December 11, 2025 |
| July 10, 2025 | |
| Title | URL | Purpose |
| Electronic Claims, Payments and Remits | https://online.flippingbook.com/view/704125376/ | EDI, ERA, and EFT information |
| Claims Guest Access User Guide | https://online.flippingbook.com/view/477228264/ | Walkthrough of the guest user guide for Online Affiliate |