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Eligibility for HMO members
Overview
Emergency Prospective Review Program (EPRP)
Post-admission case management and concurrent review
Case Management Hub contact information
Overview
Consistent with applicable law, Kaiser Permanente members are covered for emergency care needed to clinically stabilize their situation. Kaiser Permanente's Emergency Prospective Review Program (EPRP) has access to member medical records which can help expedite your diagnosis when one of our members presents to your emergency room and also inform further care.
You can contact EPRP prior to stabilization when clinically appropriate to receive relevant patient-specific medical history information which can assist you in stabilizing our member who is your patient. Once our member has been stabilized, you must contact EPRP for authorization to provide post-stabilization care.
The EPRP call center is available to you 24 hours, 7 days a week. It is staffed by practicing emergency physicians and emergency qualified clinical support staff who are available to speak directly with your Emergency Department physicians and staff.
Emergency Prospective Review Program (EPRP)
(800) 447-3777
Available 7 days a week / 24 hours a day
Emergency Prospective Review Program (EPRP)
If you are a contracted provider specific requirements for the use of EPRP are listed in Section 4 of the Provider Manual. If you are a provider that is not contracted with Kaiser Permanente, please download the details of requirements applicable to you.
EPRP staff can assist you by providing up-to-date clinical information and general medical history about Northern and Southern California members of the Kaiser Permanente Medical Care Program.
EPRP can also confirm eligibility and provide important benefit information, like member cost share.
When EPRP agrees that a member must receive post-stabilization care at your facility, EPRP will authorize you to provide the initial agreed upon post-stabilization care.
Working together, your Emergency Department physician and a KP emergency physician can make alternative care arrangements such as securing follow-up services at a local KP facility or transferring the member to a KP or a KP-contracted facility. EPRP will also arrange for appropriate ambulance transport when necessary to accomplish the transfer.
Post-admission case management and concurrent review
Please observe the following best practices for post-admission case management and concurrent review.
If EPRP authorizes our member’s admission to your facility, Kaiser Permanente’s Outside Services Case Manager will follow that member’s care until discharge or transfer. In order to ensure approval for continued post-stabilization care at your facility, you should maintain contact with the appropriate Kaiser Permanente Outside Services Case Management Hub. Case Management Hub contact information is listed below.
If our member was admitted to your facility as part of the stabilizing process and you did not previously contact EPRP, you must contact the appropriate Kaiser Permanente Outside Services Case Management Hub once the member’s condition is clinically stable to discuss authorization for continued admission as well as any additional appropriate post-stabilization care. You should use the Case Management Hub contact information listed below.
The Outside Services Case Managers and Kaiser Permanente physicians will conduct concurrent review in collaboration with your facility. The review may be done telephonically or on site in accordance with your facility's and Kaiser Permanente’s policies.
Case Management Hub contact information
Below you will find the specific contact information for the Case Management Hub, which provides support for all Northern California Kaiser Permanente Members admitted in any non-KP hospital, including those admitted Members out of the KP service area and out of the country.
Main Phone Line: (925) 926-7303
Toll free phone line: 1-888-859-0880
eFax: 1-877-327-3370