A member's health plan may not cover all referred services required to provide medical care. Review Services processes service coverage requests and provides written notification to the member and provider of an approval or denial for coverage.
Review Services performs the following tasks:
- Reviewing practitioner coverage determination requests.
- Making the coverage notice available to the referring and referred-to practitioners online.
- Sending a copy of the coverage notice to the referring and referred-to practitioners and the patient.
- Serving as the primary point-of-contact for providers for authorization-related issues.
Requesting prior authorization
Kaiser Permanente believes in the importance of the primary care provider or personal physician in managing care for our members. We expect the primary care provider to be the manager and coordinator of all consulting specialist care and the provider of as much care as possible for our members.
Review Services must preauthorize coverage for care provided by contracted consulting specialists for most of our plans. Primary care providers must submit prior authorization requests using our online Referral Request tool .
Note: Please refer members only to practitioners appearing in our provider directory. If you request a practitioner who is not on the directory, the request may require additional review.
Review Services staff may request additional, supporting information, including:
- Chart notes and medical records
- Lab and radiology requests and results
- Clinical indicators, based on our clinical criteria
Please fax information to 1-800-377-8853 (this is for additional documentation only - not for prior authorization requests). We may deny your request if we do not receive additional required supporting information.
To expedite patient care, please check the CPT code in the Pre-Auth Code Check Tool. The tool will inform you if an authorization is needed. If it is needed and there is documentation indicated for the review, please attach those records to your referral request in Affiliate Link.
Content on this page is from the provider manual | Disclaimer