Inform us of your practice changes

Alternative medicine providers

Chiropractors, Naturopaths, Massage Therapists and Acupuncturists please email Tivity at provider.updates@tivityhealth.com

Mental health providers

Use the MHS Practitioner Add Form for active contracts only. If you do not know if you are directly contracted with Kaiser Permanente, please reach out to your organization’s contracting department.

We have limited needs within our network for new contracts. Please review the following page: Network Status Matrix and Contracting with KPWA for additional information.

Unsolicited requests may be declined if there is no business need.

Delegated organizations

Delegated Organizations/Providers List (PDF)
These types of changes require contract and system updates. A 90-day notice is required because the changes affect provider directory listings, authorizations, and claims processing and payment.

All other providers/organizations:

Submit a Practice, organization and billing changes form for the following:

Tax ID name and/or Tax ID changes

• Tax ID name changes require a signed contract amendment and a system update
• Tax ID changes require a system update
• Acquisition – An acquisition is when an entity purchases a company or multiple companies. Requires advance notice and the bill of sale/acquisition contract signed by both parties to update the contract
• Assignment – An assignment is when an entity transfers the rights and obligations under its current contract with Kaiser Permanente to a new owner. If the new contract owner does not accept the existing contract terms, we cannot issue an assignment. A W9 is required to update the contract

Billing NPI changes (changes to NPI type)

• Adding or changing NPI numbers
• Changing NPI type

If you are enrolled in Electronic Funds Transfer you must also notify InstaMed of Billing NPI and Tax ID changes.
Email: support@instamed.com
Phone: 1-877-833-6821

Termination

• Individual practitioner - Use the Individual practitioner termination form to terminate a practitioner from your contract with Kaiser Permanente
• Full contract – Use the Provider Contract Termination form to terminate your full contract with Kaiser Permanente
• Delegated organizations/providers – Please contact your credentialing specialist to follow the roster notification process. Please refer to the Delegated Organizations/Providers List to determine if your organization is a delegated organization/provider

Add a practitioner

Use the Individual practitioner add form for active contracts only. If you do not know if you are directly contracted with Kaiser Permanente, please reach out to your organization’s contracting department. We have limited needs within our network for new contracts. Please review the following page: Contracting with Kaiser Permanente.

If credentialing is required, please allow 60-90 days for processing once a complete credentialing application is received. You may check credentialing status periodically by contacting the Credentialing department at kpwapcq@kp.org

Unsolicited requests may be declined if there is no business need.