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Download our authorization policies to learn more about our utilization management and authorizations process, including:
- the role of the Utilization Management Operations Center, our centralized
- authorization and referral department
- referral policies and procedures
- hospital and facility admissions
- case management
- denials and appeals
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 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™
Out-of-Area PPO
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: