Eligibility & Claims

Permanente Advantage DOES NOT provide eligibility or benefit information.  The process for verifying eligibility is determined by the member’s designated region. As a provider, you are encouraged to verify eligibility for ALL KPIC PPO and POS members. Do not assume that coverage is in effect because they have an established Kaiser Permanente member ID card.

Please call the appropriate Regional Member Services Department phone number on the back of your member’s ID card or below for eligibility and benefits questions.

Kaiser Member Services Contact Centers

California (Northern & Southern) Member Services – 800-788-0710 option 1
Colorado Member Services – 855-364-3184
Georgia Member Services – 855-364-3185 (TTY 711 )
Hawaii Member Services – 800-238-5742
Mid-Atlantic States Member Services – 888-225-7202

Permanente Advantage DOES NOT process claims or claims appeals. Permanente Advantage CANNOT provide information on claim status or Explanation of Benefits (EOB). Please call the appropriate Claims Department phone number on the back of your member’s ID card or below for ALL claims questions.

Non-Emergency Medical Service Claims Only

California (Southern) with POINT-OF-SERVICE PLAN, PPO, & OUT OF AREA INDEMNITY PLAN

KFHP – Claims Department
P.O. Box 7004
Downey, CA 90242-7004
Member Services
800-778-0710

California (Northern) with POINT-OF-SERVICE PLAN, PPO, & OUT OF AREA INDEMNITY PLAN
KFHP – Claims Department
P.O. Box 12923
Oakland, CA 94604-2923
Member Services
800-778-0710

Colorado
National claims Administration - colorado
PO Box 373150
Denver, CO 80237-9998
Payor ID: 91617
Clearinghouse: WedMD (Emdeon), ENS (COKSR)
Member Services
855-364-3184

Georgia
Kaiser Permanente Claims Administration - Georgia
PO Box 370010
Denver, CO 80237-9998
Payor ID: 21313
Clearinghouse: KPIC
Member Services
855-364-3185 (TTY 711)

Hawaii with POINT-OF-SERVICE PLAN
Kaiser Claims Administration - Hawaii
PO Box 378021
Denver, CO 80237
Payor ID: 94123
Clearinghouse: EDI
Member Services
800-238-5742

Mid-Atlantic (MD, DC, or VA) with FLEXIBLE CHOICE, AON ADDED CHOICE, AND OUT-OF-AREA PPO
Kaiser Claims Administration – Mid-Atlantic
PO BOX 371860
Denver CO, 80237-9998
Payor ID: 52095
Member Services
888-225-7202