Claims | Community Provider Portal (2024)

New Update: As of 9/1/2020, Claim Status can only be obtained through one of our self-service tools.

Sign-onorRegisterto access KP Online Affiliate, orview claim status as a guest user.

Electronic Claims Submissions, Payments (EFT) and Remits

We’re making changes to improve your EFT/ERA enrollment!

Kaiser Permanente is in the process of moving electronic funds transfer and electronic remittance advice (EFT/ERA) enrollments to a new portal.

Once the new portal is active, this page will be updated with links and instructions. The tentative date range for implementation is January 20-February 21, 2022.

Please check back to this website for updated information. Until then, if you have questions or concerns, please contact EDIsupport@kp.org

Thank you. We look forward to enrolling you in EFT/ERA.

EDI Trading Partners

We encourage you to submit your claims electronically. Our EDI Trading Partners, and Payer ID’s are listed below:

Claims tools

Claims submission through Office Ally Direct Data Entry (DDE) Solution.

• Learn more about free claims submission throughOffice Ally DDE Solution
• Submit claims electronically and receive confirmation immediately
• Correct failed claims directly on website
• Convenient, secure, and HIPAA compliant
• 24/7 access from anywhere with an internet connection

Registerfor Office Ally DDE Solution

Video Overview ofOffice Ally DDE Solution

Online submission of disputes, appeals and supporting claim documents

We are excited to share with you a new Online Affiliate feature that allows you to upload claim related documents. This new functionality will allow you to take the following action on a claim:

• File a Dispute (appealing/disputing claim decisions).Select this option if you are requesting reconsideration of payment.
• Respond to a Request for Information (RFI) by allowing the upload of Kaiser requested documents.Select this option if you have received a letter or EOP denial for additional information.
• Submit Supporting Documentation.Select this option if you have submitted a claim that you know will require supportive documents.

Sign onorRegisterto access KP Online Affiliate and start using this feature today!

Claims procedures

For information about submitting claims to us, please download ourclaims procedures guidelines^♦, which includes information about:

• billing procedures
• "clean claim" requirements
• coding standards
• our multiple-procedure reimbursem*nt policy
• Medicare billing
• the provider payment-dispute process

For information about how to submit claims for self-funded members, download our claims procedures located in ourSelf-funded provider manual^♦.

Disputes and appeals

Claims disputes Member appeals

Claims disputes

You may now submit online disputes or appeals online via theOnline Affiliateportal.Sign-Onorregisterto access KP Online Affiliate and start using this feature today!

If you disagree with the handling of a claim, you should first call Member Services at 301-468-6000 to inquire about the claim. In most cases, they will be able to answer your questions and resolve any issues you may have.

For further information on fully-funded claims, please refer to theFully-funded provider manual.

For information on self-funded claims, call 1-877-740-4117.

Member appeals

Members have the right to file a grievance or appeal when they disagree with the Health Plan's decision not to authorize necessary medical services or not to pay for a claim.

Download ourappeals policy for members♦, which outlines the appeals process and provides contact information.

For further information on fully-funded appeals, please refer to theFully-funded provider manual.

♦You will need the freeAdobe Acrobat Readerto read this file.

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ICD-10 information

Overview

Kaiser Permanente is fully compliant with the legal requirements put forth by the Centers for Medicare & Medicaid Services (CMS) in the ICD-10 mandate. As of October 1, 2015, we began processing claims submitted with ICD-10 codes for dates of service (outpatient) or dates of discharge (inpatient) on or after October 1, 2015.

ICD-10 Frequently Asked Questions (FAQs)

For more information about KP’s ICD-10 authorizations and referrals policy, please see theKP Authorization and Referrals FAQ.

ICD-10 Claims Submission Rules

Kaiser Permanente has chosen to adopt CMS' EDI guidelines for ICD-10, specifically for claims that span the implementation deadline. Please seeMLN Matters®Number: SE1408 Revisedfor specific instructions.

Important contacts

ICD-10 contacts
If, after reviewing KP’s ICD-10 Readiness FAQs, you still have questions related to KP’s ICD-10 implementation, please send an e-mail to:ICD10-Information@kp.org.

Useful ICD-10 links

For additional ICD-10 information, you may refer to these useful links from the

Centers for Medicare and Medicaid Services (CMS):

• CMS ICD-10 Official Information page
• CMS Provider Resources