Dispute resolution process for nonreportable events

This is an outline of Kaiser Permanente's formal dispute resolution process available to eligible practitioners who have been denied initial credentialing or recredentialing for administrative reasons, such as failure to meet credentialing criteria, privileging criteria, or both.

Brief summary of process

Following an action by our Credentialing Committee to deny the application for initial credentialing, recredentialing, or privileges, the credentialing director or designee will send a notice of action to the affected practitioner.

To initiate the dispute resolution process, the affected practitioner must submit a written request for review to the credentialing director or designee no later than 30 days following receipt of the notice of action. The practitioner may submit additional information for consideration or request a personal meeting. The practitioner may have an authorized representative attend the meeting with him or her or on their behalf.

If additional information is submitted, we will notify the practitioner of our determination within 21 days of receipt of the information. If a meeting is requested, we will respond within 14 days after the conclusion of the dispute meeting.

If the practitioner has exhausted the dispute resolution process and is not satisfied with our determination, he or she may request mediation by submitting a written request to the credentialing director or designee no later than 14 days following receipt of our determination. The request for mediation shall constitute the practitioner's promise to pay one half of an approved mediator's charges.

Contact Information

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

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

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