New users Register to access KP Online Affiliate
OneHealthPort (OHP) users Sign-On. After signing on at OHP Continue to KP Online Affiliate
Existing non OHP KP Online Affiliate Users Sign-On or Manage Account

Claims

We're going paperless! Providers can avoid postal delays and get paid faster by enrolling in Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA). To learn more about how to enroll please see our EDI, EFT and ERA Guide.

Electronic Claims Submissions (EDI), Payments (EFT) and Remits (ERA)

Kaiser Permanente urges you to submit all claims via Electronic Data Interchange (EDI). You may submit EDI claims Electronic Data Interchange (EDI) is an electronic exchange of information, in a standardized format that adheres to all Health Insurance Portability and Accountability Act (HIPAA) requirements. It is the transfers of structured data, by agreed message standards, from one computer system to another without human intervention.

Benefits of Electronic Data Interchange (EDI) transmission include:

Reduced Overhead Expenses
Improved Data Accuracy
Reduced Turnaround Time for Claims Processing
Bypass U.S. Mail Delivery
Go Green! Reduce paper, mail time and postal mail costs

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:

Clearing house	Northern CA	Southern CA	Hawaii	Georgia	Northwest	Mid-Atlantic	Colorado
Office Ally	94135	94134	94123	21313	NW002	52095	91617
Navicure	N/A	N/A	N/A	21313	N/A	N/A	N/A
Availity (formerly REALMED)	N/A	N/A	N/A	N/A	N/A	54294	N/A
SSI	NKAIERCA	SKAISERCA	94123	21313	SS002	52095	999990273
Relay Health Alternate IDs	RH009 94135 KS003	94134 KS001	RH0011 94123	RH008 21313 NG010	RH002 93079 NG009	RH010 NG008	RH003 91617 COKSR
Optum Insight/ Ingenix	N/A	N/A	N/A	NG010	NG009	NG008	COKSR
Trizetto	KS003	94134	94123	21313	KS003	52095	COKSR

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

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

Kaiser Permanente has partnered with Citi Payment Exchange to provide a portal for enrolling in Electronic Fund Transfer (EFT) and Electronic Remittance Advice (ERA). With this partnership, Kaiser Permanente requests that all vendors pursuing EFT/ERA enrollments utilize the Payment Exchange portal for enrollment and changes to existing EFT/ERA. The portal is open 24 hours a day and 7 days a week for new enrollments or changes.

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 Northwest region,

Click here to enter a secure portal.
Activation code R3ML96 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.

Provider Claims Inquiry

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

If you require additional assistance, you may contact the Claims Inquiry Unit at 503-735-2727.

Provider Claim Payment Appeals Process

Please note that all claim payment appeal requests must be filed within 365 days of the date the claim was originally processed or denied, in order to be considered for payment by Kaiser Permanente.

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

Check the status of submitted claims on our claims guest access site. No login required but you will need specific details about the claim to view the status.

National Claims Administration Claims Recovery Mailing Addresses By Region
Region		Address	City	State	Zip Code
California - NCAL	Kaiser Permanente Recovery, NCAL	PO Box 742120	Los Angeles	CA	90074-2120
TPMG	KP TPMG Refunds	PO Box 743375	Los Angeles	CA	90074-3375
California - SCAL	Kaiser Permanente Attn: Regional Claims Recovery	PO Box 741639	Los Angeles	CA	90074-1639
Colorado	Kaiser Foundation Health Plan of Colorado	PO Box 740812	Los Angeles	CA	90074-0812
Georgia	Kaiser Foundation Health Plan of Georgia	PO Box 403032	Atlanta	GA	30384-3032
Hawaii	Kaiser Foundation Health Plan of Hawaii	PO Box 745820	Los Angeles	CA	90074-5820
Mid-Atlantic	Kaiser Foundation Health Plan Mid Atlantic	PO Box 740814	Los Angeles	CA	90074-0814
Northwest	Kaiser Foundation Health Plan of Northwest	PO Box 745854	Los Angeles	CA	90074-5854
Washington State	Kaiser Foundation Health Plan of WA	PO Box 748945	Los Angeles	CA	90074-8945

Kaiser Permanente Policies cover a multitude of topics affecting claims payment. Our current published policies are linked below.

Clinical Review Payment Determination Policy

Intraoperative Neuromonitoring Policy

Acute Care UM Hospital Timely Notification Policy (PDF)

If you have questions about our policies posted here, please contact us with your questions at NWProviderRelations@kp.org.

Download the Waiver of Liability Statement form (non-contracted Medicare Advantage providers)

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”

Claims Submission Addresses

If you are unable to submit claims electronically, see below for mailing addresses

Note: Claims are to be submitted according to where the membership is held, not where the provider is practicing.

National Claims Administration By Region
Region	Phone	Address	City	State	Zip Code
California - NCAL	800-464-4000	PO Box 8002	Pleasanton	CA	94588-8602
California - SCAL	800-464-4000	PO Box 7004	Downey	CA	90242-8004
Colorado	303-338-3800	PO Box 373150	Denver	CO	80237-3150
Georgia	888-865-5813	PO Box 370010	Denver	CO	80237-0010
Hawaii	800-966-5955	PO Box 378021	Denver	CO	80237-8021
Mid-Atlantic	800-777-7902	PO Box 371860	Denver	CO	80237-9998
Northwest	503-813-2000	PO Box 370050	Denver	CO	80237-9998
Washington State	888-901-4636	PO Box 30766	Salt Lake City	UT	84130-0766
KPIC Self-Funded	800-533-1833	PO Box 30547	Salt Lake City	UT	84130-0547
Ambulance Claims		Relations Insurance - KP Ambulance Claims PO Box 853915	Richardson	TX	78085-3915