Claims submission requirements

All claims must be submitted using standard industry formats, forms, and coding, and claims data must be supported by documentation in the patient's medical record.

Claims submission standards require that we deny claims with missing or invalid information, are handwritten, have any handwritten notations, stamps, or stickers on them, or are not on an original CMS-1500 form printed in red.

The Claims Submission Standards and Specification have been updated. For specific information on requirements and recommendations, please see the Paper claim submission standards and specifications grid (PDF) .

Three essential components must be included with each submitted claim:

Patient and subscriber information: Include the patient's Kaiser Permanente member ID number and name as it appears on their ID card and your patient identification information. Include other insurance or subscriber information if applicable.

Provider information: To avoid an error or delay in claims payment, notify Provider Contracting or Provider Services as early as possible of any changes to your tax ID number (TIN), address, name, or to how you use or designate your entity National Provider Identifier (NPI). For more information, see NPI and taxonomy requirements.

Coding: We expect all claims to be submitted with industry-standard coding and that procedures be reported with the HCPCS/CPT codes that most comprehensively describe the services performed. For more information, see Standard coding for services provided.

The Kaiser Permanente Payor ID is 91051

Content on this page is from the provider manual | Disclaimer