Authorizations

To view authorizations, you will be asked to sign on to our secure provider tools. A new page will open in your browser window.

• View authorizations

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™

• Maryland
• District of Columbia
• Virginia

Out-of-Area PPO

• Maryland
• District of Columbia
• Virginia

Providers may request pre-certification by either:

1. Calling Permanente Advantage at 1-888-567-6847; or
2. 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:

• MarylandProviderRequests@kponcall.com

To help meet the growing demand for mental health services, we have expanded the list of procedures that do not require pre-authorization. This is effective immediately, and we will update the list if any changes are made in the future.

Kaiser Permanente members may contact a Behavioral Health provider directly for an appointment. Pre-authorization is not required for the initial consultation and some routine care services. Please see below for the complete list of authorization-waived CPT codes and their corresponding descriptions.

The Kaiser Permanente Utilization Management Operations Center reviews each referral request and determines the number of visits that are medically necessary. When requesting referrals, please only request one visit or the exact number of visits that will be needed for a three (3) month period.

Additional visits can be added if medically necessary before approval but if more visits are requested than needed the member will receive a partial approval/denial letter which has been creating confusion for members as they believe their referral is being denied. To help avoid this, please only request one visit or the exact number of visits necessary.