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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
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.
Pre-Certification for KPIC PPO & POS Product Plans
Permanente Advantage, LLC ensures our members receive necessary, appropriate, and safe care while helping them navigate the health system and make the most of their benefits.
Use this link, Permanente Advantage, to access online resources that support working with Permanente Advantage and provide information about precertification.