Kaiser Permanente billing for community providers

Kaiser Permanente filing, prior authorization and portal

Appeal levels

Top denials from Kaiser Permanente

Why does Kaiser Permanente billing depend on the region?

Kaiser Permanente is a group of separate regional health plans, and each region publishes its own community provider rules. A claim goes to the member's home region, not to the region where you treated them. Kaiser's 2026 HMO Provider Manual, Section 5, says claims "should be submitted to the Member's home KP Region."

This page works from two Kaiser documents. The first is the 2026 KP HMO Provider Manual, Section 5, Claim Billing and Payment Policies and Procedures, which is the file Kaiser posts for Northern California community providers. The second is Chapter 8, Claims, of the 2023 Mid-Atlantic provider manual.

What is the Kaiser Permanente timely filing limit?

For Northern and Southern California, Kaiser's 2026 HMO Provider Manual says to submit all claims within 90 calendar days after the date of service or discharge, unless a different period is in your agreement or required by law. For Mid-Atlantic non-Medicare members, the 2023 Mid-Atlantic manual chapter says claims must be received within 180 calendar days of the date of service.

The 2026 manual adds that claims denied for being filed after the deadline "may be accepted and adjudicated" and points to the provider dispute section. In the Mid-Atlantic chapter, a resubmission with proof of the original timely submission must arrive within 180 days of the original denial or explanation of payment, or it is denied as untimely.

The Mid-Atlantic chapter accepts a system-generated claim copy or an EDI transmission report as proof of the first submission, and rejects hand-written or typed notes. For how filing clocks work across payers, see timely filing limits by payer, and run your own dates through the timely filing calculator.

Secondary claims have their own clock. Section 5 says Northern and Southern California coordination of benefits information should reach Kaiser within 90 calendar days of the primary carrier's explanation of benefits. Outside California the manual gives 12 months for commercial members and 24 months for Medicare and Medicaid members.

How do I submit claims and check status with Kaiser Permanente?

Kaiser asks community providers to send claims electronically through a clearinghouse and to use KP Online Affiliate for status. Section 5 says providers "must submit their EDI claim through a clearinghouse," and each clearinghouse assigns its own payer identifier for Kaiser. After the claim is sent, Kaiser returns a 277CA acknowledgement to the clearinghouse, which shows whether the claim was accepted or rejected.

• Office Ally payer IDs printed in the 2026 manual: 94135 for Northern California and 94134 for Southern California. The manual lists other clearinghouses and region codes in the same table.
• Use the patient's own details on the claim, not the subscriber's, and mark the patient relationship as SELF (18). Each Kaiser member has a unique medical record number for electronic transmissions.
• Put the authorization number on the claim whenever the service needed one. Section 5.8.2 says every covered service that requires prior authorization must carry the number.

Paper is the fallback. Section 5 asks for red-lined UB-04 and CMS-1500 forms and does not accept handwritten, faxed or photocopied claims. Paper claims go to the region address in Section 5.24.1.

How do I send a corrected or voided claim to Kaiser Permanente?

Send a corrected claim only after the original claim is finalized, with frequency code 7 and the original Kaiser claim number. Section 5.9.2 says replacement claims should be submitted after the original has been "paid, denied or otherwise finalized." A corrected claim with no valid original claim number is rejected.

The time you have depends on the region. Section 5.9.1 gives 90 calendar days in Colorado and 365 calendar days in Georgia, Hawaii, the Mid-Atlantic States and the Northwest, counted from the date of the original remittance advice. For California it says the same limits that apply to the original claim. The Mid-Atlantic 2023 chapter also asks for frequency type code 7 in CLM05-3 on both professional and institutional corrected claims.

What are the Kaiser Permanente appeal levels and deadlines?

Kaiser's claim dispute path starts with a reconsideration request in KP Online Affiliate, and the formal payment dispute has a deadline. The Mid-Atlantic 2023 chapter says payment disputes must be filed within 180 days of the date of the denial or explanation of payment, and that late disputes are denied as untimely. The same chapter limits the dispute process to clean claims.

The 2026 manual points to a separate provider dispute section for its other regions, so ask your Kaiser contact for your region's dispute chapter before you rely on the Mid-Atlantic numbers elsewhere.

How do I check eligibility and get prior authorization from Kaiser Permanente?

Check eligibility and benefits before any non-emergency service, and get authorization first when the service needs it. Section 5.2 says to verify eligibility and benefits before non-emergency services and to include the authorization number on the claim. It also says claims for non-emergency services that need authorization and are submitted without one "will be denied, unless otherwise required by applicable law."

That rule covers post-stabilization services too. The manual lists authorization for non-emergency services, "including post-stabilization services," as a claims requirement. Access to referrals and authorizations in KP Online Affiliate varies by region, contract status and job role.

What does Kaiser Permanente require on hospital and facility claims?

Section 5 also says claim reviewers may deny items that are inclusive of or integral to another procedure and apply CMS, NUBC and NCCI standards, along with Kaiser's payment determination policies in the POL-020 series.

How do Kaiser community provider claims work for emergency care at a non-Kaiser hospital?

A non-contracted hospital treats the emergency, then calls Kaiser before providing post-stabilization care. Kaiser's letter to non-contracted hospitals for Northern California says that once the patient is clinically stable, the hospital must contact the patient's health plan for authorization to provide post-stabilization care, whether stabilization happens in the emergency department or after admission.

• Before admission: the letter names the Emergency Prospective Review Program hotline, 1-800-447-3777, available 24 hours a day, 365 days a year. It calls that call the only accepted way to request authorization for post-stabilization care before admitting a Kaiser member.
• After admission: call the Outside Services Case Management Hub for your county once the member is clinically stable. The letter lists the South Bay, East Bay and Valley hubs and an out-of-area line.
• Psychiatric emergencies: the letter says a non-contracted hospital must call Kaiser when it transfers a member, or receives one, for a psychiatric emergency condition.
• Cost: if the hospital does not get authorization, the letter says neither Kaiser nor the member is financially responsible for unauthorized post-stabilization care, and the hospital can collect only the member's cost sharing.

For the claim itself, include the emergency department records, which the manual lists as an example of supporting documentation Kaiser may request on emergency services. For federal out-of-network rules that can apply to emergency claims, see open negotiation and how federal IDR works, and for California rules see California billing rules. City guides: Los Angeles and San Diego.

Which denials come up most on Kaiser Permanente claims?

The manual names its denial triggers directly: missing authorization, missing primary payer information, missing original claim numbers, and interim billing that does not follow its rules. The table maps each to the CARC that usually appears on the 835.