Checking claims status

You can check claim status using our Claims Status Inquiry tool regardless of whether the claim was submitted electronically or on paper. You also can review an electronic file from your billing service or clearinghouse for all pending claims, or contact the Provider Assistance Unit.

If you have checked the status of a claim submitted to Kaiser Permanente and we do not show it in our system, the following steps will help you locate your claim.

Paper claims

Paper claims sent within the last week may not be entered in our system yet. You can resubmit a claim if it has been two weeks or more since you submitted it and you have verified that it is not in our system.

Electronic claims

If you submit claims electronically using a billing service or clearinghouse, check the report for rejected claims caused by data submission errors. If errors are found, contact the service or clearinghouse for resolution. Refer to "Electronic Segment Information" in the CMS-1500 or UB-04 required fields forms to assist you in your discussion with the clearinghouse or billing service.

Data errors may occur if information is entered into the wrong box on the claim form or if any of the following information is missing or incorrect:

• NPI number
• Taxonomy
• Provider tax ID number
• Kaiser Permanente member ID number (front-filled with zero's to make eight digits)
• Member's name

The member's name must be exactly the way it appears on the member's ID card and in our system, including spaces and punctuation.

If you have electronic confirmation that Kaiser Permanente received the claim, contact the Provider Assistance Unit to initiate an investigation. Be ready to provide the following information:

• Provider tax ID number
• Kaiser Permanente member ID number
• Date of service
• Total charges submitted
• NPI number
• The name and contact information of your billing service or clearinghouse
• Type of claim (professional or institutional)
• Date and time of file submittal or expected transmittal
• Whether the missing claims are in a series or just a few out of a batch
• Start/end or pattern of problems
• Patient account number
• Contact name and phone number