Kaiser Permanente's PPO credentialing process - FAQs

These FAQs will help guide you through the PPO credentialing process at Kaiser Permanente.

What is credentialing?
Credentialing is the systematic process of collecting and verifying relevant education, training, licensure, professional references, background, and certifications to provide patient care before a provider is allowed to see Kaiser Permanente patients. This process is intended to ensure that our members receive their care from providers who are appropriately trained, licensed, and meet quality standards.

Kaiser Permanente uses a process called primary source verification to validate required credentialing information including, education, training, licensure, DEA registration, work history, hospital affiliations, and insurance coverage. This process, among others, is verified by contacting the organization that originally issued the credential to the provider.

Can a provider be contracted but not credentialed?
Credentialing and network contracting are two separate processes. If credentialing is required, the process must be successfully completed before a contract is finalized.

Do I have to submit the credentialing application for each line of business with Kaiser Permanente?
No, Kaiser Permanente will use the same credentialing application for all lines of business.

Once the information is received, Kaiser Permanente will evaluate your credentials as described above. When the credentialing process is completed, you will be notified in writing. You will be contacted separately regarding your contract status.

How are the Kaiser Permanente credentialing standards determined?
Overall, the credentialing standards are established by Kaiser Permanente's Credentialing Committees and the Quality Committee of the Board of Directors. Additional standards are set by the National Committee for Quality Assurance (NCQA), Det Norske Veritas (DNV), the Accreditation Association for Ambulatory Healthcare (AAAHC), professional colleges and boards for various specialties, state licensing boards, and other external regulators.

Will I be notified if erroneous information is discovered during the credentialing process?
Yes, the Kaiser Permanente Provider Credentialing Department will notify you if erroneous information is discovered during the verification process from any primary source. It will be your responsibility to work directly with the Kaiser Permanente Credentialing Specialist and/or reporting entity or entities to correct the erroneous information.

How will I be notified when I have successfully been credentialed by Kaiser Permanente?
When the credentialing process is completed, you will be notified in writing. You will be contacted separately regarding your contract status.

How often are credentials reviewed?
All credentialed providers are recredentialed at least every three years.