Kaiser Permanente billing and credentialing
Billing for community providers who see Kaiser Permanente members through referrals, emergencies and contracted networks.
Working with Kaiser Permanente
Kaiser Permanente is an integrated system that provides most care through its own medical groups and hospitals. Community providers are paid mainly for authorized referrals, emergency and urgent care, and services under specific contracts.
Plan types we bill:
- Commercial HMO
- Medicare Advantage
- Medicaid in some regions
Credentialing and enrollment
Contracting is done region by region. Without a contract, care for non-emergency services usually needs a Kaiser referral to be paid.
Prepare
Licenses, NPI, CAQH and group details checked and updated.
Apply
Application submitted for each provider and location.
Follow up
Status checked every 1 to 2 weeks until approval.
Confirm
Effective date and participation confirmed before billing.
Claims, eligibility and portals
Claims go to the Kaiser region where the member is enrolled, with the referral number when one applies.
Denials we prevent with Kaiser Permanente
- Non-emergency care without a referral
- Claim sent to the wrong Kaiser region
- Services beyond the referral
- Emergency claims without the required notification
Questions about Kaiser Permanente
Can we bill Kaiser for a walk-in patient?
For emergencies, usually yes. For routine care, Kaiser normally requires a referral.
Other payers and related services
Trademarks belong to their owners. MedAi Billing Solutions is an independent billing company, not affiliated with any payer or government agency.
Get help with Kaiser Permanente claims
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.