Electronic Claims Submissions (EDI), Payments (EFT) and Remits (ERA)
For complete information on claims filing requirements or processing, please refer to your agreement or contact the administrator for the applicable product.
Electronic Data Interchange (EDI) is an electronic exchange of information, in a standardized format that adheres to all Health Insurance Portability and Accountability Act (HIPAA) requirements. It is the transfers of structured data, by agreed message standards, from one computer system to another without human intervention.
Benefits of Electronic Data Interchange (EDI) transmission include:
Reduced Overhead Expenses
Improved Data Accuracy
Reduced Turnaround Time for Claims Processing
Bypass U.S. Mail Delivery
Go Green! Reduce paper, mail time and postal mail costs
Listed below is the electronic submission of claims transactions:
837P Claim/Encounter - This is used for professional services and supplier.
837I Claim/Encounter - This is used by facilities and hospitals.
Please note: Payer IDs are for both 837I (UB) and 837P (CMS1500) transactions.
KPIC Self-Funded EPO/Self-Funded Product members For instructions on how to submit EDI claims for KPIC Self-Funded EPO/Self-Funded Product members, please refer to the Self-Funded Provider Manual for Contracted Institutional Providers . You may contact 866-921-5310 (toll free) for any additional questions.
KPIC Fully Insured EPO/KPIC Deductible for Individuals Product members For KPIC Fully Insured EPO/KPIC Deductible for Individuals Product members, please contact 866-921-5310 (toll free) for instructions on submitting EDI.
We encourage you to submit your claims electronically. Our EDI Trading Partners, and Payer ID's are listed below:
Claims submission through Office Ally for bulk claims submissions and for direct entry claim submissions to Kaiser Permanente. Claims submissions to KP are FREE for providers.
Instructions: Under Practice Software section, select “Clearinghouse”, “Start for Free”, and “Signup”
Kaiser Permanente’s EFT/ERA enrollment process has changed, and we are not extending enrollment to non-contracted vendors at this time. Please check back here periodically for additional process changes. Contracted providers can reach out to their Kaiser Permanente contact to begin the enrollment process.
Current EFT/ERA enrollees will continue to have access to the Citi Portal to make updates to their profile.
Processing time of new enrollments and changes in current enrollments have been slower than typical. We appreciate your patience while we work through these unexpected delays.
Frequently Asked Questions
If I’ve submitted a change or an enrollment request, what should I expect next? Continue to check Citi Payment Exchange for status updates. Once approved in the portal, Kaiser Permanente will update the system. If you continue to receive paper checks, contact EDI Support by submitting a Support Case to: https://kpnationalclaims.my.site.com/EDI/s/
Can I remove a bank account from my profile in Citi Payment Exchange? Yes, you can also unshare a bank account with a region/payer under Settings. The provider may have more than one bank account set up per region (sub designations are made by adding an NPI) and UNSHARE is the appropriate action if you want to keep one account and remove another one.
Can I change my demographic information through Citi Payment Exchange? You can log into your current Citi account to make most changes. If you need additional support, contact EDI Support by submitting a Support Case for more information: https://kpnationalclaims.my.site.com/EDI/s/
Can I cancel my EFT/ERA setup? Yes, you can revoke the link between your account and the EFT/ERA vendor.
Within the Payment Exchange portal, provider will select Payers > click the Payer > then select Revoke. That will cancel the enrollment altogether with that payer (region).
Important Note: If you are a provider retrieving ERAs from a clearinghouse, you must remember to complete the ERA setup with your clearinghouse as well as with your KP contract manager.
You may now submit appeals online via the Online Affiliate portal.
Sign on or Register to access KP Online Affiliate and start using this feature today.
Health Plan provides all providers with a fast, fair, and cost-effective dispute resolution mechanism under which you may submit all disputes regarding invoices, billing determinations, or other contract issues. We will handle disputes and this dispute resolution mechanism in accordance with applicable law. Please make sure that you review your agreement and the applicable law for a complete description of the dispute resolution process.
For more information on the provider appeals processes, call:
HMO/DHMO/Senior Advantage 800-464-4000
KPIC Self-Funded EPO or Self-Funded Product 800-533-1833
KPIC Deductible for Individuals Product or Fully Insured EPO 866-213-3062
The claims communication information found here is in addition to the annual communication Affiliate providers receive to meet compliance and regulatory requirements. The information below includes tools and other materials we want you to share to make your partnership with KP the best!
Online Affiliate
Did you know that you have access to claim status online? The days of waiting on hold to check claim status are over! Learn more about what Online Affiliate can offer to you and your staff.
Electronic Data Interchange (EDI), Electronic Fund Transfers (EFT), and Electronic Remittance Advice (ERA)
Go paperless and get connected with Electronic Data Interchange (EDI) and Electronic Fund Transfers (EFT)! You can also view Electronic Remittance Advice (ERA). For more information and our EDI payer IDs, refer to the Electronic Claim Submission, Payments (EFT) and Remits tab.
The NCA Provider Notification is a reminder that Kaiser Permanente only accepts completed claims as defined by California legal and regulatory requirements. The letter outlines the minimum acceptable submission and suggests using EDI to submit claims. If you are unable to use Electronic Data Interchange to submit claims, you can use the CMS 1500 form and be sure to include all required information as outlined in the NCA Provider Notification letter.
As a reminder, you can find a summary of our claims submission requirements and settlement practices as well as a description of our provider dispute resolution mechanisms.
Claims Frequently Asked Questions (FAQs)
Kaiser Permanente’s National Claims Administration has developed FAQs to address common and frequent questions from a limited number of our specialty provider groups. These FAQs are intended to supplement and not replace the provider’s contract and supporting documents or state and federal regulations. If your specialty is not listed here, please reference the Provider Manual for Institutional providers, or the Annual Mailings for Professional Providers for more information.
Allowed amount is the qualifying payment amount for each item or service. The qualifying payment amount applies for purposes of the recognized amount. The qualifying payment amount was determined in compliance with this regulation. If you wish to initiate a 30-day open negotiation period for purposes of determining the amount of the total payment, as applicable, visit provider.multiplan.com, or contact MultiPlan at NSAService@multiplan.com or 888-593-7427. If the 30-day negotiation period does not result in a determination, you may initiate the independent dispute resolution process within 4 days after the end of the open negotiation period.
The qualifying payment amount for all items or services was determined based on an underlying fee schedule or derived amount.
If you wish for more information about how the qualifying payment amount for items or services provided, then please refer to the contact info on your EOP or 835.
We can provide the detailed payment information for the new items or services based on the existing code(s) for items and services, if requested.
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