With access to the secure provider website, users can view patient coverage, benefit and copay information, and check the status of referral requests online. Practitioners have access to medical information obtained from patient visits with Kaiser Permanente and a wide range of online reference tools.
Provider Demographic Request
Please submit all demographic changes in writing on company letterhead to the Provider Relations department at 855-414-2623 or email: Provider.Demographics@kp.org
Note: Delegated providers should not use this form. Please contact your delegated representative for demographic updates.
Request an on-site orientation
This form lets you request a formal Kaiser Permanente on-site orientation for your practice. The form must be completed and faxed to Provider Relations at
855-414-2620.
Request a provider manual
Use this form to request that a Kaiser Permanente provider manual be sent to you in the mail.
External referral and authorization form
View an example of our new Kaiser Permanente referral form.
Uniform consultation referral form
Use this form to request a referral.
Behavioral Health Uniform Treatment Plan Form
Use this form to submit continuing behavioral health treatment plans.Provider
Provider Payment Dispute Resolution Form
Use this form to file an appeal or level of payment dispute.
Attestation Forms for Third Party Liability (TPL) for Medical Support Enforcement Beneficiaries
Use the following forms when billing for Maryland Medicaid TPL Medical Support Enforcement Beneficiary claims: