We ask our vendors, contractors, and subcontractors to follow the Principles of Responsibility and guidelines for compliance issued by the Office of Inspector General of the U.S. Department of Health and Human Services.
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.
Also, vendors, contractors, and subcontractors are asked to follow the Code of Conduct when providing goods and services to Kaiser Permanente.
Please share the Code of Conduct with all employees providing goods and services to Kaiser Permanente and its members and patients.
As a provider of health care services, Kaiser Permanente must follow all applicable laws, regulations, and standards. We also must follow the guidelines for compliance issued by the Office of Inspector General of the U.S. Department of Health and Human Services. These guidelines indicate that vendors, contractors, and subcontractors who partner with Kaiser Permanente should follow the same compliance guidelines as Kaiser Permanente while working on Kaiser Permanente business.
The Kaiser Permanente Compliance site provides the resources you will need as a vendor, contractor, or subcontractor to learn about Kaiser Permanente's compliance requirements and to help ensure that all of us are doing our part to maintain high standards of ethics and integrity.
Everyone who works with Kaiser Permanente is accountable for helping to keep things right - and for speaking up when something isn't. If you have a compliance concern, or think that a compliance, ethics, or integrity standard has been violated, call the toll-free Kaiser Permanente Compliance Hotline at 888-774-9100.
The Compliance and Ethics Hotline is available 24 hours a day, 7 days a week, 365 days a year. When you call, you can choose to remain anonymous.
Learn about our policies for provider and supplier contracting, gifts and business courtesies, visitation, and changes to business address, name or TIN.
All providers and suppliers are required to notify the National Provider Contracting and Network Management office when any the following changes occur:
Business address changes: All providers and suppliers are required to notify the National Provider Contracting and Network Management office at least 30 days prior to any address changes.
Business name change, mergers or acquisitions: All providers and suppliers are required to notify the National Provider Contracting and Network Management office immediately prior to changes due to a business name, merger or acquisition.
Tax Identification Number Changes (TIN): All providers and suppliers are required to notify the National Provider Contracting and Network Management office at least 30 days prior to the effective date of any Tax Identification Number (TIN) change.
Product recalls in the medical sector are becoming ever more common. To track the growing number of recalls occurring every year, National Provider Contracting and Network Management (NPCNM) uses the National Product Recall Program at Kaiser Permanente.
Communication is the key to resolving any supplier recall situation. If you have a recall, market withdrawal, or medical device safety alert, notify NPCNM’s Provider Relation’s department in writing and by phone (818-557-6126 and 510-268-5473).
In addition to notifying NPCNM, contact the National Product Recall Team by email to KP-Product-Recall@kp.org or by phone at (510) 625-3124.
The team will document the recall and track the progress made in resolving the recall.
The National Product Recall Team will ask several questions to understand the impact on Kaiser Permanente. They will want to know:
What type of recall is involved?
How many members are directly affected by the recall?
Which of Kaiser Permanente's regions are affected?
Which specific members are impacted?
What is the resolution plan to retrieve and replace the product?
When will recall resolution be complete?
Who is the primary contact at your organization on matters related to the recall?
Business continuity can be described as a multidisciplinary approach used to review and validate a contingency plan for how an organization will recover, either partially or completely, business-critical functions when a disaster or extended disruption in service occurs.
Business continuity also includes how an organization prepares for future incidents that could jeopardize the organization’s core mission or long-term health. These are examples of incidents that might trigger a need for business continuity plans to go into effect:
Local: Building fires
Regional: Earthquakes, floods, area fires
National: Pandemic illnesses
Kaiser Permanente has a robust business continuity plan for our integrated delivery system of care. Our organization also depends upon our community-contracted suppliers as an extension of our delivery system during these events and we encourage proactive communication and close coordination of services.
To communicate and coordinate services for impacted Kaiser Permanente members, nationally contracted suppliers should contact National Provider Contracting and Network Management Provider Relations at 818-557-6126 and 510-268-5473.
For answers to questions or more information about what you've found here, please contact the National Provider Contracting and Network Management team.
If you have questions about policies that aren't included in this website or would like more information about what you've found here, please contact the National Buy to Pay and Sourcing team.
National Buy to Pay, Sourcing
Attention: Contract Management
Kaiser Foundation Health Plan
1800 Harrison Street
Oakland, CA 94612
careathome-sourcing@kp.org
If you have questions about your existing agreement within the categories of dental services, diabetes prevention programs, and any affinity service that aren't included in this website or would like more information about what you've found here, please contact the National Provider Contracting and Strategy team.
National Provider Contracting and Strategy
Attention: Contract Management
Kaiser Foundation Health Plan
300 Lakeside Drive, 13th Floor
Oakland, California 94612
Telephone: 510-268-5525
If you have questions about transplant services or policies that aren't included in this website or would like more information about what you've found here, please contact the National Claims Administration, Provider Data Management & Contracting team.
National Claims Administration,
Provider Data Management & Contracting
Attention: Transplant Contract Management
Kaiser Foundation Health Plan
300 Lakeside Drive, 13th Floor
Oakland, California 94612
Telephone: 510-268-5473
Access listings for provider relations, member services call centers, and other useful contacts in each region.
KPHealthConnect Online-Affiliate
If you are a Kaiser Permanente contracted provider and are interested in learning more about KPHealthConnect Online-Affiliate, please email Permanente Affiliated Provider Services at KP-NCAL-OnlineAffiliate@kp.org.
Provider contact information
For answers to questions or to obtain additional contact information, please refer to Section 2: Key Contacts of the Northern California Provider Manual for HMO members for useful contact information.
KPHealthConnect Online-Affiliate
If you are a Kaiser Permanente contracted provider and are interested in learning more about KPHealthConnect Online-Affiliate, please call Permanente Affiliated Provider Services at 626-405-3289
If you have completed the KPHealthConnect Online-Affiliate enrollment process, received your National User Identification Number, and are unable to sign on, please call the Help Desk at 1-888-457-4872 (toll free). Choose Option 1 for HealthConnect support and identify yourself as a "KPHealthConnect Online-Affiliate" user.
Provider contact information
For answers to questions or to obtain additional information, please refer to Southern California Provider contact information.
Claims contact information
For claims filing requirements or status inquiries, you may contact Kaiser Permanente by calling 1-800-390-3510 or refer to claims contact information for Southern California.
Referral information
The Outside Referral Department (ORD) is responsible for coordinating and tracking authorized referrals. Pease consult the Outside Referral Services Department (ORD) Referral Coordinator for your Kaiser Permanente Medical Center.
KPHealthConnect Online-Affiliate
For contracted providers in Colorado, if you need additional assistance, please contact us at 866-214-2434 or 303-338-3216 within the Denver/Boulder area, or email us at CO-Affiliate-Link@kp.org. You can leave a message 24 hours a day. Your inquiry will be responded to within 24 hours.
Colorado Network Development Provider and Contracting Department
The Kaiser Permanente of Colorado Network Development Provider and Contracting Department is committed to providing support to you and your staff. This includes responding to your operational inquiries and providing education regarding new products and plans.
Please contact Provider Experience at (866) 866-3951 for answers to questions or to obtain additional information.
Referral information
If you have questions regarding the referral you have received, please contact the Referral Center at 303-636-3131 during business hours of 8:30am to 5:00 pm MST, Monday through Friday. You will need to leave a message during the lunch hour of 12pm to 1pm. Messages left during the lunch hour will be returned within the same day. Messages left outside of business hours will be returned the following business day.
Provider Relations contacts
If you have questions about policies not included in this website, or would like more information about what you've found here, please call Provider Relations at 877-465-0029 (toll-free) or 404-364-4934.
The Provider Relations Department is available Monday through Friday, from 8:30 a.m. to 5:00 p.m. ET.
Kaiser Permanente Call Center
The Kaiser Permanente Call Center for the Georgia region provides telephone access to members who are seeking appointment scheduling services or telephone advice.
Kaiser Permanente Departments and services
If you would like to contact a specific Kaiser Permanente department or service, please refer to this contact list for the Georgia region.
Authorizations
Contact Authorization and Referral Management for information about authorizations procedures including denials and appeals.
Monday – Friday 8 am – 5 pm
Phone: 1-808-432-5687
Fax: 1-808-432-5691 or 1-808-432-5667
Claims Customer Service
Contact Claims Customer Service for general claims information and billing questions, claim payment status, claims submission.
Monday – Friday 8 am – 4:30 pm
Phone: 1-877-875-3805
Fax: 1-808-432-5433
Customer Service
Contact Customer Service for general eligibility questions and benefit verification.
Monday – Friday 7:45 am – 5:00 pm
Saturday – 8 am – 12 pm
Oahu 1-808-432-5955
Toll Free 1-800-966-5955
Hearing or Speech Impaired Toll Free:1-877-447-5990 (TTY)
Fax: 1-808-432-5300
Neighbor Island Transfer Coordinators
Routine transfers (808) 432-7252
After Hours (808)432-7250
Fax: (808) 432-7251
Emergency Hotline
For emergency transfers to Kaiser Permanente Moanalua Medical Center & routine transfers after clinic hours:
1-808-432-7030
24 hours
Provider Contracting and Relations
Provider Contracting and Relations is available to update provider demographic information such as tax ID change, address change, addition of providers, and termination of providers.
1-808-432-5429
Fax: 1-808-432-5667
Monday – Friday 7:45 am – 4:30 pm
Provider Contracting and Relations
711 Kapiolani, 1st Floor
Honolulu, Hawaii 96813
Additional contact information
Additional contact information is available for download in Chapter 2 of the Affiliated Provider Manual.
Provider Relations
The Provider Relations department is available Monday through Friday, from 9:00 a.m. to 5:00 p.m. Call Provider Relations at 1-877-806-7470 for:
Member Services
Call Member Services at 1-800-810-4766 for questions about:
Referrals and authorizations
The Utilization Management Operations Center is the Mid-Atlantic State's centralized authorizations and referrals department for Kaiser Permanente. The Utilization Management Operations Center provides comprehensive access and utilization information 24 hours a day, 7 days a week.
Contact the Utilization Management Operations Center staff at 1-800-810-4766 if you would like assistance in the following areas:
Provider Relations
Provider demographic updates, such as tax ID change, address change, addition of providers, termination of providers. Provider education and training. Contract questions.
503-813-3376
Member Services
General enrollment questions. Eligibility and benefit verification. Copay, deductible, and coinsurance information. Members presenting with no Kaiser Permanente identification number.
503-813-2000 or 1-800-813-2000
8 a.m. to 6 p.m.
Claims
Claims - general. Claim payment status. Claims submission. Coordination of benefits. Third-party liability. Workers Compensation.
503-735-2727 or 1-866-441-1221
Claims (refunds)
Questions regarding refund requests.
503-813-1900 or 1-800-756-2777
Provider Services
For information about joining our network, or to inform us of a change to your practice.
206-988-2000
KPWA.provider-services@kp.org
Provider Assistance Unit (PAU)
For status updates or issues with claims and referrals.
1-888-767-4670
Kaiser Permanente Departments and services
If you would like to contact a specific Kaiser Permanente department or service, please refer to this contact list for the Washington region.
The Durable Medical Equipment (DME) and Prosthetics and Orthotics (P&O) Manual outlines our processes and procedures for providers and may be downloaded by sections.
The DME/P&O Manual provides guidelines for the administration of Kaiser Permanente's operational requirements for Durable Medical Equipment (DME) and Prosthetics and Orthotics (P&O).
NOTE: This DME/P&O Manual is pending approval by the Maryland State Regulators and should not be used by Maryland providers until all reviews have been completed.
This manual may be downloaded by sections. Consult the Table of Contents to determine which section will most appropriately assist you.
Section 1: How This Manual is Organized
Section 2: Kaiser Permanente Medical Care Program
Section 3: Contracting for Services
Section 4: Key Contacts
Section 5: Member Eligibility
Section 6: Member Rights & Responsibilities
Section 7: Provider Rights & Responsibilities
Section 8: Member Complaints and Grievance
Section 9: Vendor Integrity
Section 10: Claims
Section 11: Referrals/Authorization
Section 12: Provider Appeals
Section 13: Utilization Management
Section 14: Quality Management
Section 15: Confidentiality of Member Records
Section 16: HIPAA Privacy Rules
Section 17: Appendix (pdf) & Forms instruction (xlsx)
Effective January 1, 2009, for the Northern and Southern California regions, Senate Bill 853, also known as the California Language Assistance Program (CALAP) requires all contracted providers to offer interpreter services to members for whom English is not their primary language.
Kaiser Permanente will provide written notification if a member needs interpreter services. For complete instructions and documentation refer to the Kaiser Permanente implementation notice for Senate Bill 853 - California Language Assistance Program (CALAP).
All services will be paid by Kaiser Permanente. Interpreter services are provided through:
Language Line (spoken word):
Offers 140 languages
24 hours a day/7 days a week
888-898-1301
Northern California DME referrals ONLY:
Language Assistance Providers Paid For By Kaiser Permanente
| Type Of Service |
Language | Company | Scheduling | Data Elements Required |
Cancellation Policy |
|---|---|---|---|---|---|
| Telephonic Interpreter |
Over 200 Languages |
Language Line |
(888) 898-1301 |
|
N/A |
| In-person Interpreter |
American Sign Language |
Interpreting and Consulting Services,Inc |
(888) 615-0016 |
|
Appointments must be cancelled 24 hours in advance of appointment |
| In-person Interpreter |
American Sign Language |
Partners in Communication LLC |
(800) 975-8150 | ||
| In-person Interpreter |
American Sign Language |
Bay Area Communication Access |
(415) 356-0405 |
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