Claims procedures

Payment policies

Payment Policies

Claims procedures

Use the links below to access information about our Billing and Claims policies and procedures.

• Checking Claims Status
• Claims Adjustments
• Claims Explanation of Payment/835 Remittance Advice & Reimbursement
• Caring for Kaiser Permanente Members from Other Regions
• Claims Submission Requirements
• CMS-1500 Claims — Coding for Services Provided
• Coordination of Benefits
• Copayments
• Deductibles and Coinsurance
• Electronic Batch Transactions
• Electronic Funds Transfer and Electronic Remittance Advice
• Medicare Coordination of Benefits
• Members' Financial Responsibilities
• Motor Vehicle Accidents
• NPI (National Provider Identifier) and Taxonomy
• Outpatient Prospective Payment System/Ambulatory Payment Classifications
• Paper Claims
• Physician Reimbursement for Medical (Non-Psychiatric), Surgical, and Anesthesia Services
• Requests for Additional Claims Documentation
• Submission of Claim Supporting Documents
• Submitting Secondary Claims
• Timely Filing of Claims
• Work-Related Injuries

Claims review process

Use the links below to access information about provider reconsiderations:

• Provider Reconsiderations Conducted Within Kaiser Permanente
  • Reconsideration Time Frames for Kaiser Permanente Conducted Reconsiderations
  • Medicare Advantage Non-Contracted Provider Appeal Rights
  • Claims (Non-Authorization Related)
  • Claims (Authorization/Clinical Review Related)
  • Pre-Payment
• Reconsiderations Conducted Outside Kaiser Permanente
  • Diagnosis Related Group (DRG) Payment and Review (Cotiviti)
  • Optum
  • WA Balance Billing Protection Act
  • Federal No Surprise Billing Act

Member forms

Encourage members to use our online claims forms, available on our secure member website.

Secure business tools

Claims Status Inquiry 
Check the status of claims you've submitted in the past six months.

Eligibility Inquiry 
Verify a member's coverage and benefit levels.