Motor vehicle accidents

When a Kaiser Permanente member is receiving care for injuries related to a motor vehicle accident, you should bill claims directly to the member's automobile insurance carrier under their Personal Injury Protection (PIP) if available.

The use of box 10B marked yes on a CMS 1500 form or FL31 coded with 01, 02, or 03 on a CMS 1450 form identifies an auto accident. If Kaiser Permanente does not know about the accident, we will investigate and notify you if an auto insurance carrier should be primary.

The member must stay within our network system to ensure coverage by Kaiser Permanente in case the carrier rejects the claim.

If the carrier denies the claim, promptly submit the claim and a copy of the denial to Kaiser Permanente. We will only consider claims filed within the timely filing limit of one year from the date of service.

In the absence of first-party coverage, submit all bills to Kaiser Permanente for consideration. You should not bill any third-party carrier for care you provide related to a motor vehicle accident.

If you have questions about a first- or third-party accident, contact our Other Party Liability Department at 1-866-783-9594.

Content on this page is from the provider manual | Disclaimer

More resources

Accident and injury incident questionnaire/other party liability (PDF)

Please encourage members to use the secure online version of this form.

Definitions

First-party insurance
Primary over Kaiser Permanente (Personal Injury Protection or PIP policies). Kaiser Permanente will not pay benefits unless a denial is received from the first-party carrier or until all first-party coverage is exhausted.

Third-party insurance
Insurance of at-fault party is responsible. Kaiser Permanente will be primary in the absence of other health insurance and will subrogate with the responsible party.