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Authorization policies
Learn about our authorizations policies, including process and procedures, denials, and appeals.
Medical coverage policies
Learn about our medical coverage policies - referral guidelines for providers.
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Authorizations policies
Download our authorization policies* to learn more about our utilization management and authorizations process, including:
- the role of the Provider Service Center, our centralized authorization and referral department
- referral policies and procedures
- hospital and facility admissions
- case management
- denials and appeals
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Medical coverage policies
We provide medical coverage policies - referral guidelines as a reference for health care professionals within the Kaiser Permanente Medical Care Program. The Kaiser Permanente Mid-Atlantic States medical coverage policies may provide details about referring patients for treatment, including the following:
- diagnosis
- indications
- contraindications
- measures prior to referral
- clinical indications for referral
- optional approaches
If you would like to receive a hard copy of the Medical Coverage Policy, UM criteria/protocol or Affirmation Statement, please contact the Utilization Management Operations Center at 1-800-810-4766 and follow the prompts.