Forms & Resources

Download forms

KPNW Prior Authorization Form (PDF)

Acute Care UM Hospital Timely Notification Policy (PDF)

Authorization for Medical Care
The Authorization for Medical Care will be faxed and/or mailed to provider offices to notify them that a Kaiser Permanente Northwest member has been referred to them for medical care.

Explanation of Payment (EOP) (PDF)
The Kaiser Permanente Explanation of Payment is sent to providers to inform them of how a claim was adjudicated.

Specialty Radiology Form (PDF) and Radiology Form (PDF)
Please use the attached forms when ordering Radiology Services from Kaiser Permanente.

Clinical Criteria

Kaiser Permanente NW utilizes internally-developed clinical criteria in addition to nationally-recognized clinical criteria to make utilization management decisions.  These criteria can be accessed at: Utilization Management 

Changes to Clinical Criteria: In accordance with regulatory requirements, Kaiser Permanente NW is providing 60 days’ notice of changes to clinical criteria before implementation. Review the criteria changes here.