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.

Kaiser Permanente’s EFT/ERA enrollment process has changed, and we are not extending enrollment to non-contracted vendors at this time. Please check back here periodically for additional process changes. Contracted providers can reach out to their Kaiser Permanente contact to begin the enrollment process.

Current EFT/ERA enrollees will continue to have access to the Citi Portal to make updates to their profile.

Processing time of new enrollments and changes in current enrollments have been slower than typical. We appreciate your patience while we work through these unexpected delays.

Frequently Asked Questions

If I’ve submitted a change or an enrollment request, what should I expect next?
Continue to check Citi Payment Exchange for status updates. Once approved in the portal, Kaiser Permanente will 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 and remove another one.

Can I change my demographic information through Citi Payment Exchange?
You can log into your current Citi account to make most changes. If you need additional support, contact EDI Support by submitting a Support Case for more information: 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 your KP contract manager.

If the claim is normally submitted via EDI, the corrected claim can be submitted via EDI as long the claim is identified as a corrected claim and includes the original claim # in the EDI transaction. If the original claim number is not included, the claim will be rejected before it gets to the claims processing system, as the original claim # is a required data element in the EDI transaction.

If claim is submitted via paper CMS 1500-- corrected claims need to be submitted on preprinted red claim forms, in box 22 the resubmission code is 7 (replacement claim) and the original reference # would be the original claim # that this claim is replacing. Do not stamp or note “Corrected Claim” on the form as it interferes with the OCR process causing delays in processing.

If claim is submitted via paper UB 04-- corrected claims need to be submitted on preprinted red claim forms the right most number in the type of bill field needs to be a 7 (example: 137). Please note the original claim # in box 64 of the corresponding line (A,B,or C) to which Kaiser Permanente is identified as the payor in block 50. Example Kaiser Permanente is identified as the payor in box 50A. The original claim number would be provided in box 64A. Do not stamp or note "Corrected Claim" on the form as it interferes with OCR process causing delays in processing.