Total Knee and Total Hip Replacement Surgery Changes
Effective Jan. 2, 2020: CMS has approved total knee and total hip surgeries at hospital outpatient venues and ambulatory surgery centers.
On behalf of Kaiser Permanente Colorado, we wish to extend our appreciation for the high-quality care you deliver to our members.
We want to ensure you are aware of a change to the Centers for Medicare and Medicaid Services (CMS) venue requirements regarding total knee and total hip replacement surgeries. Effective Jan. 2, 2020, the following is now allowed:
1.) Medicare total KNEE replacements will be allowed in Ambulatory Surgery Centers (ASCs) beginning Jan 2, 2020.
2.) Medicare total HIP replacements will be removed from CMS inpatient only (IPO) and moved Hospital Outpatient Dept (HOPD) beginning Jan. 2, 2020.
As you know, we strive to constantly provide affordable, convenient and safe surgical options for our Kaiser Permanente members. We know that with outpatient surgery patients may be able to get home more quickly to recover.
Our request is that moving forward, as a Kaiser Permanente network provider, you perform any appropriate Kaiser Permanente members’ total knee or total hip replacements in a contracted hospital outpatient setting or contracted ASC. Per our contracted agreement, we reserve the right to redirect care based on venue.
Thank you for your attention to these matters as our members trust their care is delivered according to our provider services agreement. Feel free to call your provider representative at 1-866-866-3951 if you have additional questions.
Kaiser Permanente Hospital Contract and Provider Relations
In the Spotlight
Affiliate Link (AFL) – Tired of waiting in a queue to confirm authorization or claims status?
Affiliate Link is your best resource for viewing eligibility/benefits, ordering referrals, authorizations, and viewing claims including printing an Explanation of Payment (EOP). We have also added the new capability of submitting an order for laboratory and radiology to be completed at a Kaiser Permanente facility.
Important reminder: In the past, AFL has been an option to use, however, AFL will soon be your only option to submit a referral and authorization. All calls for status to our call center will be rerouted to AFL. Get your team prepared for these changes by registering for AFL access. A step-by-step guide is available at http://providers.kaiserpermanente.org/html/cpp_cod/index.html. If you have training needs, we will provide access to quick link tutorials or you can reach out to your provider representative at 1-866-866-3951.
New Feature: A Quick Way to View Claims Status
Contracted and non-contracted providers can now view their claim status as a guest user without registering on Affiliate Link (AFL). To access as a guest user, 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 the claim is not found in the guest user system, please call the claims phone number listed on the back of the member’s ID card. To view claim status as a guest, go to https://epiclink-guest-co.kp.org/claims_co/tapestry/claims/ or you can access the link from the Colorado Community Provider Portal home page.
Please note this new claim feature does not replace AFL. The claims data in AFL is significantly more detailed and has more robust search ability.
Coming Soon to Affiliate Link and the Colorado Community Provider Portal
We’re continually looking for ways to improve your experience with Kaiser Permanente. We’re adding features to Affiliate Link (AFL) with order entry to enhance referral process including lab and radiology, in addition to the ability to view/print Remittance Advice. And, look for updates to the Provider Manual on the Colorado Community Provider Portal in October.
Claims Payment is Tied to Provider Data Attestation
Per a DOI regulation, providers receive a quarterly email from Kaiser Permanente Colorado requesting attestation to various data elements for practitioners on their roster. Our records show only 24% of providers are responding to the request. The information providers are asked to attest to includes elements such as practice locations, hospital affiliations, panel statuses, languages, and specialties.
To respond, you can simply email their updates or a confirmation that all information is correct to KPCO-PDM@kp.org
If you’re getting this attestation or have questions, please email us at KPCO-PDM@kp.org.
ABCs of Kaiser Permanente Mail Order Pharmacy
Kaiser Permanente members can save significantly on their prescription medications – often the cost of one or two copays for a 90-day supply – when they use our mail order pharmacy service. It’s easy as easy as A B C for you to send your patients’ subscriptions to our mail order pharmacy – here’s the different options available to you:
A – If you use SureScript through your EMR, you can send the prescription/s electronically to Kaiser Permanente mail order pharmacy.
B – Call us at 1-866-523-6059 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m.
C – Fax the written prescription/s to 1-866-551-9628
Once you’ve sent the prescription/s through to us, Kaiser Permanente members registered on kp.org can order their prescriptions for delivery within 3-5 days at kp.org/pharmacy – this only takes a moment and members need to have a credit card ready for payment. If a member prefers to call, they can speak to a mail order representative at 1-866-523-6059 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m.
New urgent and emergency care options available for Kaiser Permanente members
Kaiser Permanente covers urgent and emergency care services anywhere in the world. For urgent and emergency care closer to home, Kaiser Permanente keeps expanding access, with more than 60 convenient locations now available to Colorado members in Denver/Boulder, Mountain Colorado, Northern Colorado, and Southern Colorado.
Find convenient urgent and emergency care locations for your Kaiser Permanente patients:
- Visit kp.org/locations for the most up-to-date information - search by service area, zip code, and more
- Call the Appointment and Advice Contact Center anytime, day or night:
Denver/Boulder: 303-338-4545 (TTY 711)
Mountain and Northern Colorado: 970-207-7171 (TTY 711)
Southern Colorado: 1-800-218-1059 (TTY 711)
- Download and print our new location guides at kp.org/getcare. These feature information about our medical offices, urgent and emergency care options for members, and more.