CLAIMS REVIEW PROCESS FOR KAISER PERMANENTE WHEN KAISER IS YOUR PRIMARY INSURANCE, AND YOU HAVE SECONDARY COVERAGE
Please follow the directions below if Kaiser Permanente (KP) is your primary health coverage, and you would like to submit receipts for services outside of KP to your secondary insurance carrier. This process should expedite.
1. When a member obtains services at a KP facility and the member is asked to pay a copay, he/she should ask the representative checking them in for an "Insurance Receipt". This will allow them to submit an itemized bill to another insurance company for processing.
2. When members utilize services outside of KP and would like to submit the claim to another carrier for payment, members should initially submit the itemized bill that includes the provider’s name, address, phone number, and the ICD 9 code, with a completed claim form, to the KP Claims Department for
consideration/denial. The Claims Department address is:
Kaiser Foundation Health Plan, Inc. Claims Department P.O.Box 7004 Downey, CA 90242-7004
Members can access a copy of the claim form at www.kp.org
The form is located under "A Member", the
region is Southern California, and go to tab marked "Your Plan". The drop down list will have "Forms and Publications", where there will be an underscored bullet for "Claim of Emergency Medical Services". Download this PDF version of the claim form to complete and send to the above address. Keep in mind that if members walk claims into the local Member Services Department, it can delay the process. The form should indicate that the claim is for Routine Services not an Emergency, because Kaiser’s claims system is basically set up under the HMO for Emergency Claims only. When Kaiser processors review the claim, they are looking for ways to see if they can pay the claim. Therefore, the process could take longer, and may generate a request for additional information from you to support the claim. Please make sure you clearly indicate that the claim is for routine services outside Kaiser Permanente and that you are looking for denial of benefits so an alternate plan can pay accordingly.
The normal turn around time for a claim is 30-45 days. If you need to check the status of a claim, contact the Member Service Claims Department at 1-800-390-3510.