Provider E-News

Monthly newsletter with information about clinical practice and business updates. Newsletters are in print-friendly PDF format.

February 2023 (PDF)

  • Interpretive services for our members
  • Authorization code range updates
  • Chemo denervation update
  • Reminder regarding high-end imaging authorization requests
  • Viewing contracts in Eligibility & Inquiry tool on Affiliate Link
  • HEDIS® Medical Record Review Season: February – May 2023

January 2023 (PDF)

  • Updated visiting member process
  • Kaiser Permanente’s first-fill plan expansion in place
  • New fax number for DME
  • Clinical updates
  • Continuing education opportunities

November 2022 (PDF)

  • How to obtain copies of authorizations through Affiliate Link
  • New Referral Management Unit fax number
  • New process in place for Kaiser Permanente Exponent Health
  • Let us know if you've made recent changes to your practice

October 2022 (PDF)

  • Kaiser Permanente receives a 4.5 Medicare Star quality rating for 2023
  • New membership system coming soon
  • Member contracts now available on the secure provider portal
  • News from Kaiser Permanente Washington Health Research Institute

August 2022 (PDF)

  • Caring for members from other KP regions
  • NPPES update reminder
  • News from Kaiser Permanente Washington Health Research Institute
  • Continuing medical education opportunities

July 2022 (PDF)

  • Affiliate Link tip
  • Bremerton mental health facility relocation
  • Crosswalk for mapping plan names with network names
  • News from Kaiser Permanente Washington Health Research Institute
  • Continuing medical education opportunities

May 2022 (PDF)

  • Summary of Care communications restarting
  • Help us protect member PHI
  • Interventional radiology referral template is live
  • Osteoporosis and Weight Management Guidelines updated
  • Continuing medical education opportunities
  • Let us know if you've made changes to your practice

April 2022 (PDF)

  • Authorization code ranges format update
  • HEDIS® medical record review season: February - May 2022
  • Clinical chart validation short stay reviews to begin soon
  • Your Kaiser Permanente patients have access to free online Better Choices, Better Health® self-management workshops
  • Updated clinical guidelines
  • Payment policy updates and provider notices
  • CME and workshop opportunities

February 2022 (PDF)

  • Authorization no longer required for mental health outpatient therapy or psychiatry
  • Fax is the preferred method for ordering imaging to Radiology
  • Historical Referral tool being removed in March
  • HEDIS® Medical Record Review Season
  • After hours care options available to your Kaiser Permanente patients
  • HR133 Legislation
  • Updated clinical guidelines
  • Payment policy updates

January 2022 (PDF)

  • Support for HR-133 provider directory validation
  • Transplant services provider manual update
  • Monitored Anesthesia Care (MAC)
  • New claims pre-pay email inbox for inquiries
  • Clinical review criteria change for continuity of care
  • COVID vaccine billing for Medicare Advantage enrollees
  • Provider payment policy updates

November 2021 (PDF)

  • Legislation brings changes to directory validation
  • Tip – searching for authorization codes
  • Payment policy update – Robotic Assisted Surgery
  • Diagnostic Related Group (DRG) prepay reviews
  • Affiliate link update for home infusion referrals
  • Pharmacy updates
  • Virtual care options
  • Provider payment policy updates and notices
  • CME and workshop opportunities

October 2021 (PDF)

  • CMS awards Kaiser Permanente 5 stars for its Medicare Advantage plans
  • Kaiser Permanente’s employee vaccination efforts
  • Ivermectin not approved or covered for treating COVID-19
  • New provider resources for self-administered medications
  • Changes to home infusion and ambulatory infusion suite
  • Payment policy updates
  • Personal injury protection vs. medical payments
  • Clinical guidelines updates
  • Provider payment policy updates and notices
  • Medicare Part D benefit coverage updates
  • CME and workshop opportunities

August 2021 (PDF)

  • Important changes to medical necessity review criteria for high-end imaging site of care
  • Changes to medical necessity review criteria for certain elective surgical procedures
  • Philips recalls Respironics PAP equipment and ventilators
  • Celebrating the first anniversary of Affiliate Link
  • Electronic prior authorization for Kaiser Permanente Medicare patients
  • Please note recently expired and soon to expire OIC COVID-19 orders
  • Ensuring successful transfer of Kaiser Permanente patients to Kaiser Permanente affiliated hospitals
  • What is subrogation?
  • Ensure providers are contracted with us when ordering services for patients
  • Upcoming changes

July 2021 (PDF)

  • Aducanumab (Aduhelm) treatment for Alzheimer's Disease approved by FDA under accelerated approval pathway
  • Third party liability - researching pedestrian and bicycle injuries
  • Mental Health and Wellness referrals easier to request on Affiliate Link
  • New chronic opioid therapy and combination opioid and Benzodiazepine patient education campaign
  • Updated migraine and tension headache guideline includes new options for prophylaxis
  • Upcoming changes
  • Medicare formulary updates

May 2021 (PDF)

  • Change to how Affiliate Link users access referral notifications
  • Service delivery standards added to Provider Manual
  • Diagnosis Related Group (DRG) reviews set to begin June 1st
  • Reminder: Always verify patient coverage prior to visit
  • Resubmitting your third-party liability bill may not be the answer
  • Only use category 1 CPT codes for ABA services
  • Streamlining mental health & wellness authorization and reauthorization requests
  • Depression guidelines update
  • Cervical cancer screening guideline updated - primary hrHPV is now default test
  • Medicare Part D benefit coverage - product removal
  • Upcoming changes

April 2021 (PDF)

  • Other Party Liability Unit
  • Provider Reconsideration request form changes
  • Contacting Kaiser Permanente when one hospital needs to transfer a patient to another hospital
  • Special instructions for submitting prior authorization requests in Affiliate Link
  • Post service: Claims payment review & reconsideration process
  • Asthma diagnosis and treatment guideline update
  • Back pain guideline update
  • Diabetes guidelines update
  • Drug utilization management exception process
  • Updated prior authorization criteria for average chronic opioid dose
  • Learning collaborative opportunity
  • Notification of Part D Negative formulary change 2021

February 2021 (PDF)

  • Update: First call guide for ambulance partnerships for Kaiser Permanente
  • Threshold decrease for claims pre-payment and medical necessity review for inpatient and outpatient claims
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  • Timely filing of claims involving a coordination of benefits
  • HEDIS® medical record review season: February - May 2021
  • Reminder - we can't accept CDs for reconsideration and appeals
  • 1099 form requests
  • Online referral request tools you can use today
  • Retail flu vaccine options extended to March 31, 2021
  • Routine hepatitis C screening now recommended for all adults - not just baby boomers
  • Non-invasive prenatal fetal testing - temporary change extended to March 15, 2021
  • Medical necessity review guidelines for substance use disorder treatment

January 2021 (PDF)

  • Elimination of CPT code 99201
  • Threshold decrease for claims pre-payment and medical necessity review for inpatient and outpatient claims
  • HEDIS® medical record review season: February - May 2021
  • Terminology for our online resources
  • Affiliate Link reminders and updates
  • Retail flu vaccine options extended to March 31, 2021
  • Mandatory telemedicine training for all licensed, registered, or certified health care professionals.
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  • New guideline provides treatment options for patients with opioid use disorder
  • CDC drops azithromycin from gonorrhea treatment recommendations

November 2020 (PDF)

  • COVID-19 household prevention program resources available
  • Important changes effective 1/1/2021 to our Women's Health payment policy
  • Kaiser Permanente offering $0 copay for primary care visits for Medicare Advantage members through December 2020
  • We need your help to transfer your patients' refills to Kaiser Permanente mail order
  • Acupuncture Medicare benefit for chronic low back pain
  • Generic albuterol HFA (Proventil) is Kaiser Permanente's preferred short-acting beta agonist
  • 30-day supply limit added for opioids, benzodiazepines, and non-benzodiazepine receptor agaonists (Z-drugs) for KP Commercial Plans
  • Upcoming changes

October 2020 (PDF)

  • Kaiser Permanente offers $0 copay for primary care office visits for Medicare Advantage members through December 2020
  • Women's health care performed by non-network providers requires prior authorization
  • Flu campaign toolkit
  • New ways to deliver flu shots to our members
  • Updated guidelines

August 2020 (PDF)

  • More authorizations upgrades going live on August 17
  • Kaiser Permanente walk-in pharmacy opening in Bellingham on August 20, 2020
  • Expedited appeals
  • New ambulance partnerships for Kaiser Permanente
  • Kaiser Permanente will not reopen CareClinic by Kaiser Permanente at Bartell Drugs locations
  • Upcoming changes