Kaiser Authorization

Member cost share and eligibility verification: 1(888) 576-6789

Prior authorization is required as a condition of payment for any inpatient and outpatient

services (excluding emergency services) that are otherwise covered by a Member’s benefit

plan.

Authorization can be requested from KP by contacting the appropriate Referral Coordinator or Outside Services Case Manager.

In the event additional services were rendered to the Member without prior authorization

(other than investigational or experimental therapies or other non-covered services), the

Provider will be paid for the provision of such services in a licensed acute care hospital if

the services were related to services that were previously authorized and when all the

following conditions are met:

The services were medically necessary at the time they were provided;
The services were provided after KP normal business hours; and
A system that provides for the availability of a KP representative or an alternative

means of contact through an electronic system, including voice mail or electronic

mail, was not available. For example, KP could not/did not respond to a request for

authorization within 30 minutes after the request was made.

NOTE: Authorization from KP is required even when KP is the secondary payor. Authorization Numbers are Required for Payment

KP requires that authorization numbers be included on all claims submitted by not only

SNFs, but all ancillary providers that provide services to KP Members (e.g., mobile

radiology vendors). Denials and Provider Appeals

Information about a denial or the appeal procedures is available by contacting the Coverage

Decision Support Unit (CDSU) or Self-Funded Customer Service. Please refer to the written

denial notice for applicable contact information or Self-Funded Customer Service.

When a denial is made, the requesting Provider is given the information below. Providers

may also contact the issuing department that is identified in the letter for additional

information.