Provider E-News

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

May 2023 (PDF)

• Affiliate Link in-basket view change
• Kaiser Foundation Hospitals and Geisinger Health launch Risant Health
• Provider notices
• Mental health awareness month
• CME calendar

April 2023 (PDF)

• The top-ranked medical group in Washington state
• Emergency medical services for Kaiser Permanente members
• Changes to medical necessity review criteria for Total Hip Arthroplasty
• Updates to fax numbers
• CME calendar

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