Authorizations

Authorization Information

Requests for referrals for medically necessary services may be initiated by the Kaiser Permanente clinician or the community clinician providing medical services through an authorized referral. Most medical and diagnostic services are available within the Kaiser Permanente program or our network of preferred providers. Members are referred to the preferred provider network or community resources when medically necessary services are not available within the Kaiser Permanente program.

Instructions for Pre-Authorization Form (PDF)

New Added Choice Authorization Request (PDF)

Acute Care UM Hospital Timely Notification Policy (PDF)

Northwest Regional Referral Center

The majority of Kaiser Permanente’s referrals are processed through the Kaiser Permanente Northwest Regional Referral Center. However, we have three areas within our region that process their own referrals. For information regarding those areas that do not utilize the Regional Referral Center, please see additional options below.

Admission to Skilled Nursing Facility (SNF)

Authorization for SNF admission must be obtained through the SNF Placement Coordinator at 503-499-5438.

Authorization for Home Health/Hospice Services

Authorization for Home Health and Hospice Services must be obtained through the Continuing Care Services Utilization Manager at 503-499-5253.

Durable Medical Equipment (DME)

All DME, prosthetics, and orthotics require preauthorization by the DME department. The DME department creates an authorization after receiving an order from a Kaiser Permanente Northwest clinician and it has been determined that the member meets the medical criteria for the specific DME item.         
 
Authorization letters are sent directly to the member or to the DME provider.  If additional items are needed or any change is needed in the authorization, approval must be obtained by the DME provider prior to dispensing the item.  DME providers who have questions can call the DME department at 503-813-4550

View authorizations

Access to view detailed information will be available through OneHealthPort. Please register if you do not already have a OneHealthPort account!

Referral Policy

Upon receipt of an approved authorization form, you should:

Place the copy of the Authorization For Medical Care Form in the member’s chart.

Forward all work-up results to the referring provider with any other pertinent clinical information pertaining to the consultation, and call the referring provider, if your findings are urgent. If you believe the member will require continued treatment or additional care beyond what is authorized, you must submit a new Referral Request to the Referral Department at 503-813-4560.

Dual Choice PPO Pre Certification:

Pre-certification guidelines Utilization Management KPNW helps make sure services are medically necessary, cost effective, and the most appropriate treatment for your patient’s condition based on nationally recognized standards. Pre-certification of certain services is required under the Dual Choice product. If you are a Cigna Healthcare PPO provider, please visit the following link to view Pre-certification guidelines applicable to Cigna Healthcare network