Claims

• Reduced Overhead Expenses - Administrative overhead expenses are reduced, because the need for handling paper claims is eliminated.
• Improved Data Accuracy - Because the claims data submitted by the provider is loaded directly into Kaiser Permanente’s computer by the clearinghouse, data accuracy is improved, as there is no need for re-keying or re-entry of data.
• Additionally, “up-front” edits applied to the claims data while information is being entered at the provider’s office, and additional payer-specific edits applied to the data by the clearinghouse before the data is transmitted to the appropriate payer for processing, increase the percentage of clean claim submissions.
• Reduced Turnaround Time - EDI claims bypass manual processes and paper handling at Kaiser Permanente; therefore, the turnaround time for processing EDI claims is substantially reduced (as compared to processing ...paper claims).
• Bypass U.S. Mail Delivery - Providers save time by bypassing the U.S. mail delivery system.
• Reduced Payer-Specific specific “Exceptions” - Industry-accepted standardized medical claim formats will tend to reduce the number of “exceptions” currently required by multiple payers.

Listed below is the electronic submission of claims transactions:

• 837P Claim/Encounter - This is used for professional services and supplier.
• 837I Claim/Encounter - This is used by facilities and hospitals.

Please note: Payer IDs are for both 837I (UB) and 837P (CMS1500) transactions.

We encourage you to submit your claims electronically. Our EDI Trading Partners, and Payer ID's are listed below:
 

Claims submission through Office Ally for bulk claims submissions and for direct entry claim submissions to Kaiser Permanente. Claims submissions to KP are FREE for providers.

• Learn about submitting via Office Ally
• Submit claims electronically and receive confirmation immediately
• Convenient, secure, and HIPAA compliant
• 24/7 access from anywhere with an internet connection

Sign up for Office Ally here.

Instructions: Under Practice Software section, select “Clearinghouse”, “Start for Free”, and “Signup”

Reduce turn-around-time for receipt of payments and remove overhead costs associated with handling paper correspondence by signing up for EFT/ERA today.

It’s easy to get started now!
Each Kaiser Permanente region requires a separate enrollment.
If you wish to create a new enrollment for EFT/ERA in the Mid-Atlantic region

Click here to enter a secure portal.
Activation code R4GWM4 is required at login.

Frequently Asked Questions

What if I already have EFT/ERA set up with Kaiser Permanente? Will I need to re-enroll through Citi Payment Exchange?

No, vendors with EFT/ERA already in place at Kaiser Permanente will have their account set up on their behalf. You will receive an invitation from Citi Payment Exchange to sign in and make changes or additions to your existing account. If you do nothing, your current EFT/ERA arrangements will remain as they are today.

If I’ve submitted a change or an enrollment request, what will be the turnaround time to complete the request?

Continue to check Citi Payment Exchange for status updates. Once approved in the portal, Kaiser Permanente will require 7-10 business days to update the system. If you continue to receive paper checks, contact EDI Support by submitting a Support Case to: https://kpnationalclaims.my.site.com/EDI/s/

Can I remove a bank account from my profile in Citi Payment Exchange?

Yes, you can also unshare a bank account with a region/payer under Settings.

The provider may have more than one bank account set up per region (sub designations are made by adding an NPI) and UNSHARE is the appropriate action if you want to keep one account in play but remove another one.

Can I change my demographic information through Citi Payment Exchange?

No, any demographic information changes need to be handled through Kaiser Permanente. Contact EDI Support by submitting a Support Case for more information: https://kpnationalclaims.my.site.com/EDI/s/

If I sign up for EFT in Georgia, will my California claim payments be automatically included?

No, you’ll need to request each region if not autoloaded in the initial set up of Payment Exchange.

Go to NEW region URL – sign in with activation code - using the specific activation code notifies the specific region of a new request. If the activation code is not used, the region isn’t notified of a new enrollment.

When Citi automation sees the provider information already exists, a message will pop up and direct the billing provider to log into their existing account. Once logged in and the established password is entered, the request for the new region will pop up in the “established accounts” list and the provider will be asked to link it to the existing account.

There is no limit to the number of regions a provider can be registered to bill. Providers who have multiple regions registered will all show in the “established accounts”. If you do not see your preferred region on this list, please contact EDI Support by submitting a Support Case to: https://kpnationalclaims.my.site.com/EDI/s/

Can I cancel my EFT/ERA setup?

Yes, you can revoke the link between your account and the EFT/ERA vendor.

Within the Payment Exchange portal, provider will select Payers > click the Payer > then select Revoke. That will cancel the enrollment altogether with that payer (region).

Important Note: If you are a provider retrieving ERAs from a clearinghouse, you must remember to complete the ERA setup with your clearinghouse as well as with Kaiser Permanente via the Citi Payment Exchange portal.

For information about submitting claims to us, please download our claims procedures guidelines, which includes information about:

• billing procedures
• clean claim" requirements
• coding standards
• our multiple-procedure reimbursement policy
• Medicare billing
  
• the provider payment-dispute process
  

For information about how to submit claims for self-funded members, download our claims procedures located in our Self-funded provider manual.

Are you filing claims or receiving claim payments electronically? Electronic Data Interchange (EDI) is designed to save you time and money.

Contact EDI Support

If you are interested in enrolling to submit EDI or are having issues related to EDI submissions (EDI claim rejection, missing claim, etc.), please submit a Support Case to EDI Support: https://kpnationalclaims.my.site.com/EDI/s/

Claim disputes

You may now submit online disputes or appeals online via KP Online Affiliate portal. When you submit disputes online, you will receive an acknowledgement letter and resolution letter in your Online Affiliate in-basket. Take advantage of all our claims self-service tools today!

For further information on fully-funded claims, please refer to the Fully-funded provider manual.

For information on self-funded claims, call 1-877-740-4117.

Member appeals

Members have the right to file a grievance or appeal when they disagree with the Health Plan's decision not to authorize necessary medical services or not to pay for a claim.

Download our appeals policy for members, which outlines the appeals process and provides contact information.

For further information on fully-funded appeals, please refer to the Fully-funded provider manual.

Online Affiliate is Kaiser Permanente’s self-service portal, which allows providers access to many claims features, such as:

• Check the status of submitted claims and view claim details (service date, billed amount, allowed amount, patient responsibility)
• Confirm payment information (check number, payment date, amount)

Perform the following "Take Action" on a claim

• Submit a claim inquiry related to 'denied', or 'in progress' claims
• Submit an inquiry related to a check payment, request a copy of a check or report a change of address for a specific claim.
• Submit appeals or disputes - request a reconsideration of a payment
• Respond to KP request for information

EOP/835 Verbiage

Allowed amount is the qualifying payment amount for each item or service. The qualifying payment amount applies for purposes of the recognized amount. The qualifying payment amount was determined in compliance with this regulation. If you wish to initiate a 30-day open negotiation period for purposes of determining the amount of the total payment, as applicable, visit provider.multiplan.com, or contact MultiPlan at NSAService@multiplan.com or 888-593-7427. If the 30-day negotiation period does not result in a determination, you may initiate the independent dispute resolution process within 4 days after the end of the open negotiation period.

For Air ambulance services, please send your request to air-ambulance-appeals@kp.org.

Additional Information

• The qualifying payment amount for all items or services was determined based on an underlying fee schedule or derived amount.
• If you wish for more information about how the qualifying payment amount for items or services provided, then please refer to the contact info on your EOP or 835.
• We can provide the detailed payment information for the new items or services based on the existing code(s) for items and services, if requested.

“IDR Initiation” and “Open Negotiation Notice”