Claims

Kaiser Permanente urges you to submit all claims via Electronic Data Interchange (EDI). You may submit EDI claims 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.

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.