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.
Vendor integrity program
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.
Compliance and ethics hotline
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.
National Provider Contracting and Network Management offers a fair opportunity for all providers and suppliers to obtain our business based on suitability of services offered, pricing and meeting our company’s quality needs and requirements.
Clinical Review & Payment Determination
In accordance with your agreement with Kaiser Permanente, providers can be subject to Kaiser Permanente’s Clinical Review Payment Determination policy or Line Item Deduction rule. This policy outlines that Clinical Review is responsible for reviewing facility and professional claims to ensure that providers comply with billing and coding standards, that services rendered are appropriate and medically necessary, and that payment is made in accordance with applicable contract and/or provider manual requirements.
Gifts and business courtesies
National Provider Contracting and Network Management supports cooperative business relationships with our providers and suppliers; however, it is our policy to not extend or receive gifts in any of our business relationships. All employees in the National Provider Contracting and Network Management office are prohibited from accepting gifts of any kind.
Visitation policy
National Provider Contracting and Network Management has strict guidelines with regard to provider and supplier contact with our hospitals and facilities. Visiting any Kaiser Permanente location must be arranged in advance with the National Provider Contracting and Network Management office’s approval.
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
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?
Advertising and Solicitation
Outside advertising, markings, promotional items, coupons, and sales calls to Kaiser Permanente medical facilities and soliciting Kaiser Permanente physicians or other personnel to use or refer services are prohibited. All providers and suppliers are required to contact National Provider Contracting and Network Management to discuss product or service offerings and any new technology.
Business continuity
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.
Durable Medical Equipment/Prosthetics and Orthotics Contract Management
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 BuytoPay-HomeIndependentCare@kp.org
National Provider Contracting and Strategy
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
National Transplant Contract Management
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
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.
California – Southern
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.
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.
Colorado
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.
Georgia
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.
Hawaii
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.
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.
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:
contracted rate payment questions
monthly reimbursement questions
billing inquiries
form requests
Member Services
Call Member Services at 1-800-810-4766 for questions about:
check claims status and general claims payment
member benefits
members needing care who don't have a Kaiser Permanente identification card
members terminated for greater than 90 days
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:
pre-authorization (select prompt number 2)
referrals (select prompt number 2)
hospital admissions (select prompt number 1)
reporting emergency room visits (select prompt number 1)
initiating case management (select prompt number 1)
checking member copayments or member eligibility status (select the appropriate prompt)
Northwest
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.
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.
Durable Medical Equipment/Prosthetics and Orthotics Manual
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.
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
- KP Client ID number
- KP Referral or authorization number
- Member's MRN
N/A
In-person Interpreter
American Sign Language
Interpreting and Consulting Services,Inc
(888) 615-0016
- KP Referral or authorization number
- Member's MRN
-Date(s) of appointment(s)
-Time & duration of each appointment
-Specific address & location of appointment(s)
-Any access or security measures the interpreter will need to Know and plan for to gain entry to the place of service
Appointments must be cancelled 24 hours in advance of appointment
Learn how providers can register to receive ADT notifications per requirements of the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation.
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