Forms & Resources

Download Forms and Guides

KP NW Authorization Reference Guide (PDF)
The guide serves as a reference tool for providers to better understand what services are included when an authorization is received by the Regional Referral Center. It provides visibility into covered services, review requirements, and authorization parameters, helping providers and their staff make informed decisions, coordinate care efficiently, and avoid unnecessary follow-up or resubmissions.

Important reminders:
The guide does not replace or waive prior authorization requirements.
Services that require prior authorization continue to require authorization.
The guide is intended only to identify additional related services that may already be included within an approved authorization. “

KPNW Prior Authorization Form (PDF)

Acute Care UM Hospital Timely Notification Policy (PDF)

Explanation of Payment (EOP) (PDF)
The Kaiser Permanente Explanation of Payment is sent to providers to inform them of how a claim was adjudicated.

Specialty Radiology Form (PDF) and Radiology Form (PDF)
Please use the attached forms when ordering Radiology Services from Kaiser Permanente.

Clinical Criteria

Kaiser Permanente NW utilizes internally-developed clinical criteria in addition to nationally-recognized clinical criteria to make utilization management decisions.  These criteria can be accessed at: Utilization Management 

Changes to Clinical Criteria: In accordance with regulatory requirements, Kaiser Permanente NW is providing 60 days’ notice of changes to clinical criteria before implementation.

• Review the criteria changes here. 
• Review January 1, 2027 criteria changes here.