Fair hearing and appeal process for reportable events

This is an outline of Kaiser Permanente's formal appeals process for eligible practitioners who have been denied initial credentialing, recredentialing, or privileging by Kaiser Permanente's Credentialing Committee, Board of Directors, or an authorized committee of the board. It also is the appeals process for practitioners who are the subject of an official action or recommendation for the reduction, restriction, suspension, revocation, termination, denial, or failure to renew membership, privileges, or both.

This denial decision is reportable to the National Practitioner Data Bank (NPDB), and the appropriate state licensing board in accordance with applicable law and Kaiser Permanente policy.

Brief summary of process

Following an adverse action or a recommendation for adverse action, the Credentialing Committee chair or designee will provide written notice to the affected practitioner. In order to appeal, the practitioner must send within 30 days of receiving notice a written request for a hearing and a statement explaining the basis for contesting the adverse action.

The hearing is conducted in the presence of the hearing officer, the Hearing Committee, and the practitioner. A record of the proceedings shall be maintained which, together with documentation and exhibits submitted by the parties, shall constitute the hearing record.

Within 20 days after closure of the hearing, the Hearing Committee will make a written report and recommendation and will forward those items together with the hearing record to the chair of the Credentialing Committee and to the appealing practitioner.

The Credentialing Committee will take action within 30 days after receiving the final report of the Hearing Committee. Notice of its action will be sent to the practitioner within 10 days.

If required by law, the credentialing director or designee will report the final action to the appropriate state licensing board and the NPDB. Kaiser Permanente also will send a copy of the final report to the practitioner.

Contact information

For more information or a formal description of the entire process, send your written request to:

Director, Provider Credentialing
Kaiser Foundation Health Plan of Washington
PO Box 34262
Seattle, WA 98124-9970

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