Provider information

The Provider Contracting and Relations Department welcomes you as a valued contracted provider with Kaiser Permanente. We are committed to fully supporting you, your medical support staff, and our members.

Our team is ready to respond to your operational inquiries, as well as provide education for Kaiser Permanente products and plans.

Note: This manual may be downloaded by section.

   Sections 1 and 2: Kaiser Permanente Medical Care Program and Key Contacts

   Section 3: Member Eligibility and Benefits Determination

   Section 4: Utilization Management

   Section 5: Billing and Payment

   Section 6: Provider Rights and Responsibilities

   Section 7: Quality Assurance and Improvement (QI)

   Section 8: Compliance

   Section 9: Medicare Advantage

   Section 10: Occupational Health Services

   Section 11: Self-funded Provider Manual

   Section 12: Kaiser Permanente Principles of Responsibility

   Section 13: Glossary of Terms

  Section 14: Medicaid Programs

  Section 15: Dual Choice PPO

Provider Code of Conduct

The Code of Conduct highlights some provisions in the provider agreement as well as the minimum standards by which providers are expected to conduct themselves when serving Kaiser Permanente members and patients

Acute Care UM Hospital Timely Notification Policy (PDF)

As a contracted Provider for Kaiser Permanente, you are responsible for understanding and complying with terms of your Agreement and our Provider Manual. If you have any questions regarding your rights and responsibilities under the Agreement and/or the Provider Manual, we encourage you to call our Provider Relations Department at 503-813-3376 for clarification.

To find out more about your Provider Rights and Responsibilities, see Provider Manual Section 6.

Kaiser Permanente's Principles of Responsibility articulates the key values of the organization and specifies the appropriate actions in support of those values. The Principles of Responsibility serve as a guide to our daily decisions and inform our working relationships with vendors, contractors, sub-contractors, and others.

Download our Principles of Responsibility for vendors and contractors of Kaiser Permanente.

• Provider Relations Newsletter January 2024
  
• Provider Relations Newsletter May 2023
• Provider Relations Newsletter June 2022
  
• Provider Relations Newsletter September 2021
  
• Provider Relations Newsletter January 2021
• Provider Relations Newsletter May 2020
  
• Provider Relations Newsletter April 2020
• Provider Relations Newsletter March 2020

In 2009, Senate Bill 5346 passed and led to the creation of best practices for administrative simplification in Washington through the lead organization, OneHealthPort.

We have adopted the following best practices for administrative simplification established by OneHealthPort:

• Standard Coding of Denials and Adjustments in the HIPAA 835 Remittance Advice Transaction
• Standard Notification Timeframes for Pre-Authorization Requests
• Extenuating Circumstance around Pre-Authorization and Admission Notification
• Claim Coding Policy and Edits: Standardization and Transparency
• Reconsideration of a Health Plan’s Policy Regarding Code Edits

Unless noted differently by the name of the best practice or the linked policy PDF, our business practices align with the best practice recommendations on the OneHealthPort website. To download a PDF of a best practice recommendation, go to the “Administrative Simplification Tools” section of OneHealthPort.

You may also download a copy of our Sentinel Event Policy on the Affiliate Provider Connect Portal. You can find the policy under the heading Provider Info and Credentialing and sentinel events.

Please select from the matrix below to contact us if you have any questions. If you are not sure whom to contact, please email Provider Relations at NW-Provider-Relations@kp.org

Provider Relations

Provider demographic updates, such as tax ID change, address change, addition of providers, termination of providers. Provider education and training. Contract questions.

NW-Provider-Relations@kp.org

Member Services

General enrollment questions. Eligibility and benefit verification. Copay, deductible, and coinsurance information. Members presenting with no Kaiser Permanente identification number.

8 a.m. to 6 p.m.
503-813-2000 or 1-800-813-2000 

Claims

Claims - general. Claim payment status. Claims submission. Coordination of benefits. Third-party liability. Workers Compensation.

503-735-2727 or 1-866-441-1221

Mailing Address:

Kaiser Foundation Health Plan, Northwest
Claims Administration
PO Box 370050
Denver, CO 80237-9998

Claims (refunds)

Questions regarding refund requests.
503-813-1900 or 1-800-756-2777

Now you can search for physicians, departments, facilities, and more, all in one place. Just select your area and choose the way you prefer to search. You can even narrow your results to find exactly what you need. Get phone numbers and addresses at a glance, or visit doctor and location home pages for detailed information.

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Credentialing

In order to ensure the quality of practitioners who treat Kaiser Permanente members, Kaiser Permanente credentials or provides oversight of the credentialing function for all practitioners. All practitioners must be fully credentialed and “approved to participate” before treating Kaiser Permanente members. 

To learn more about our credentialing process, please refer to our Provider Manual Section 8.

Sentinel Events

A Sentinel Event is an unexpected occurrence involving a Kaiser Permanente member that results in death or serious physical or psychological injury, or the risk thereof, or which otherwise affects the quality of care and service, operations, assets, or reputation of Kaiser Permanente.

You are required to provide IMMEDIATE notification to Kaiser Permanente in accordance with Kaiser Permanente’s Sentinel Event Policy.

All Sentinel Event reports are considered confidential and privileged quality/peer review documents. A full copy of the policy is available through Kaiser Permanente’s Quality Resource Management Department. To request a copy, call 503-813-3810.

LABORATORY DRAW SITES BY REGION