Provider selection and tiered network criteria

Provider selection criteria in Oregon and Washington

Kaiser Foundation Health Plan of the Northwest (KFHPNW) offers several networks that are comprised of the Kaiser Permanente integrated health care delivery system. The primary contracted provider groups and facilities that participate include: Northwest Permanente, P.C., Physicians and Surgeons, facilities owned and operated by Kaiser Foundation Hospitals (hospitals, Kaiser Permanente medical offices, Kaiser Permanente pharmacies), The CHP Group, and contracted hospitals. The networks contain physicians, specialists and facilities to provide services to individuals and groups covered under all Kaiser Permanente plans.

Prior to allowing network participation, providers must successfully complete the initial credentialing process and demonstrate their ongoing ability to meet credentialing standards through a re-credentialing process. Providers are required to provide the information needed to review and verify their credentials. To ensure quality and safety of care between re-credentialing cycles, Kaiser Permanente performs ongoing monitoring of the participating provider’s performance. Kaiser Permanente acts on important quality or safety issues in a timely manner by taking appropriate action against a participating provider when occurrences of poor quality are identified.

We also monitor and analyze member feedback relating to network access, availability of providers, and cultural needs and preferences. This information helps guide our network improvement efforts.

Tiered network criteria in Oregon and Washington

Kaiser Foundation Health Plan of the Northwest offers tiered networks including Oregon Added Choice, Added Choice, Added Choice + Dental Choice, Oregon PPO Plus, PPO Plus, and PPO Plus + Dental Choice. The primary contracted provider groups and facilities that participate in Tier 1 include Northwest Permanente, P.C., physicians and surgeons; facilities owned and operated by Kaiser Foundation Health Plan (Kaiser Permanente medical offices and pharmacies); Kaiser Foundation Hospitals (hospitals); and contracted hospitals.

For Members Enrolled with an Oregon Employer

The Oregon Added Choice network includes select providers and PPO providers. Select providers include the Kaiser Permanente integrated health care delivery system (as described above) and The CHP Group.

PPO providers are:

• First Choice Health Network providers in Oregon and Washington
  
• First Health Network providers in California, Colorado, Georgia, Hawaii, Maryland, Virginia, and the District of Columbia
• Cigna Healthcare^SM PPO Network¹ providers in all other states

The Oregon Added Choice network is designed to allow members access to all that Kaiser Permanente offers plus the option to seek care from providers outside our network. Select providers can be located on kp.org and www.chpgroup.com. PPO providers can be located at kp.org/choiceproducts/nw. All other providers are considered nonparticipating providers and facilities.

The Oregon PPO Plus network includes:

• Kaiser Permanente providers, Kaiser Permanente pharmacies, MedImpact pharmacies, and other PPO providers who are either employed by us or contract with us to provide covered services for members enrolled in this PPO Plus plan
• First Choice Health Network providers in Oregon and Washington
• First Health Network providers in California, Colorado, Georgia, Hawaii, Maryland, Virginia, and the District of Columbia
• Cigna Healthcare PPO Network providers in all other states

All other providers are considered nonparticipating providers and facilities. The Oregon PPO Plus network is designed to offer access to a broad provider network that includes both Kaiser Permanente providers and a nationwide network. Kaiser Permanente providers can be located on kp.org, and PPO providers can be located at kp.org/choiceproducts/nw.

For Members Enrolled with a Washington Employer

The Added Choice and Added Choice + Dental Choice networks are composed of the Kaiser Permanente integrated health care delivery system (as described above) and The CHP Group as select providers and First Choice Health PPO Network (or First Health Network for members in states other than Oregon, Washington, Idaho, Montana, Wyoming, North Dakota, South Dakota, and Alaska) as PPO providers. The Added Choice networks are designed to allow members access to all that Kaiser Permanente offers plus the option to seek care from providers outside our network. Select providers can be located on kp.org and www.chpgroup.com. PPO providers can be located at kp.org/choiceproducts/nw. All other providers are considered nonparticipating providers and facilities.

The PPO Plus network is composed of the Kaiser Permanente integrated health care delivery system (as described above) and First Choice Health PPO Network (or First Health Network for members in states other than Oregon, Washington, Idaho, Montana, Wyoming, North Dakota, South Dakota, and Alaska) as PPO providers. All other providers are considered nonparticipating providers and facilities. The PPO Plus network is designed to offer access to a broad provider network that includes both Kaiser Permanente providers and a nationwide network. Kaiser Permanente providers can be located on kp.org, and PPO providers can be located at kp.org/choiceproducts/nw.