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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)
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
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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