KAISER PERMANENTE HMO Provider Manual User Guide
- August 23, 2024
- KAISER PERMANENTE
Table of Contents
KAISER PERMANENTE HMO Provider Manual
Specifications
- Product: Kaiser Foundation Health Plan, Inc. HMO Provider Manual
- Region: Northern California
- Provider: Kaiser Permanente
Product Information
Welcome from Kaiser Permanente! The Provider Manual is designed to assist
contracted providers under HMO plans offered by Kaiser Permanente in Northern
California. It outlines various systems and procedures to ensure a successful
partnership between providers, medical support staff, and members.
The manual serves as a guide but may not cover all aspects of the relationship with Kaiser Permanente. For further inquiries, refer to the Provider agreement or contact the Medical Services Contracting Department at 844-343-9370. Additional resources can be accessed on the Community Provider Portal website: http://kp.org/providers/ncal/
Introduction to Kaiser Permanente Medical Care Program (KPMCP)
Understand the history, organizational structure, service area, integration, and other products offered by Kaiser Permanente.
Key Contacts
Familiarize yourself with key contacts within the organization for efficient communication and assistance.
Eligibility and Benefits Determination
Learn about eligibility verification, benefit coverage, membership types, benefit exclusions, limitations, and drug benefits.
Frequently Asked Questions
Q: Where can I find after-hours eligibility requests?
A: After-hours eligibility requests can be found in Section 3.1.1 of the
manual.
Q: How do I verify benefit coverage?
A: Benefit coverage verification procedures are detailed in Section 3.1.2 of
the manual.