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Claims

New Update: As of 9/1/2020, Claim Status can only be obtained through one of our self-service tools.

Sign-on or Register to access KP Online Affiliate, or view claim status as a guest user.

 

Corrected Claim submission process:

If the claim is normally submitted via EDI, the corrected claim can be submitted via EDI as long the claim is identified as a corrected claim, and includes the original claim # in the EDI transaction. If the original claim number is not included, the claim will be rejected before it gets to the claims processing system, as the original claim # is a required data element in the EDI transaction.

If claim is submitted via paper CMS 1500-- corrected claims need to be submitted on preprinted red claim forms, in box 22 the resubmission code is 7 (replacement claim) and the original reference # would be the original claim # that this claim is replacing. Do not stamp or note “Corrected Claim” on the form as it interferes with the OCR process causing delays in processing.

If claim is submitted via paper UB 04-- corrected claims need to be submitted on preprinted red claim forms the right most number in the type of bill field needs to be a 7 (example: 137). Please note the original claim # in box 64 of the corresponding line (A,B,or C) to which Kaiser Permanente is identified as the payor in block 50. Example Kaiser Permanente is identified as the payor in box 50A. The original claim number would be provided in box 64A. Do not stamp or note "Corrected Claim" on the form as it interferes with OCR process causing delays in processing.


The links below have information for utilizing Affiliate link (Online Affiliate) for submitting Disputes/Appeals/Request for Information (RFI):

View claim status as a guest user

Contracted and non-contracted providers can view their claim status as a guest user without registering. You will be asked to provide key information about a claim in question. In return, you will be able to view claim status information, including the current processing status, and, if paid, the vender and specific payment information. If your claim is not found in the Guest User system, call the phone number listed on the member’s ID card.

Claims procedures

Find out how to submit your claims electronically and obtain claims status and claim payment information.

Claims tools (NEW)

Learn more about our Claims tools and partnership.

Electronic Enrollment/Disenrollment of Electronic Funds or Electronic Remits

Kaiser Permanente Electronic Payment and Remittance Advice Centralized Enrollment Processing

Kaiser Permanente has partnered with CAQH to process Electronic Fund Transfer (EFT) and Electronic Remittance Advice (ERAs) enrollments. With this partnership, Kaiser Permanente is moving to a National EFT/ERA enrollment platform. We request that all providers pursuing EFT/ERA enrollments utilize the CAQH web portal for these activities. The portal is available 24 hours a day/seven days a week for first time enrollment or changes.

Enrolling in EFT/ERA will provide the following benefits: Receive claims payments and remittance data faster and more efficiently, reduce processing costs, and improve office workflow.

It is easy to get started now:

Visit https://solutions.caqh.org* for information and to create your secure account.

Or, speak with the CAQH EnrollHub Helpline at
1-844-815-9763. Representatives are available
7 AM - 9 PM EST Monday - Thursday and 7 AM - 7 PM EST Friday.


Kaiser Permanente contracted Clearing Houses and Electronic Data Interchange information

If you are already enrolled in ERA & EFT with other insurers, you still must enroll with Kaiser Permanente and select the correct region to receive ERA & EFT.

Important Note: If you are a provider retrieving ERAs from a clearinghouse, you must remember to also complete the ERA set up with your clearinghouse as well as with Kaiser via the CAQH EnrollHub.

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