ADDRESSING OPEN CARE GAPS IN NETWORK ADULT PRIMARY CARE PRACTICES:
At Kaiser Permanente, we know one of the most important things patients can do to maintain good health is stay up-to-date on their preventive care tests, screenings, and immunizations. With more patients coming in for face-to-face visits, we have an opportunity to catch up on closing care gaps that require an in-person touch. We ask our affiliate adult primary care practices to partner with us in getting this accomplished. Please contact your Provider Experience Consultant who can provide you a list of open care gaps for each KP member in your practice.
Kaiser Permanente is known for our integrated care and for our focus on prevention. As a network provider, you share this care gap closure goal with our mission-driven organization.
HB 19-1301 Health Insurance Coverage for Breast Imaging
The purpose of this Memorandum is to convey new state legislation on breast imaging.
Please distribute this memorandum to any Kaiser Permanente employee or provider who you believe should be made aware of this information. Please do not share this memorandum outside of Kaiser Permanente.
2. Summary of Benefit
Colorado HB 19-1301 expands coverage for noninvasive breast imaging at no cost to the member, if services are deemed appropriate by the member’s health care provider and within guidelines as determined by the American College of Radiology or the National Comprehensive Cancer Network. Breast imaging includes mammograms, 3D (digital breast tomosynthesis) mammograms, breast ultrasounds, mammary ductograms, breast MRIs, and 3D renderings of MRI/ultrasounds.
Upon biopsy or a cancer diagnosis, these services will then apply the associated cost share as listed in the member’s Evidence of Coverage (EOC), Membership Agreement, or Certificate of Insurance (COI).
Standard authorization rules apply.
This benefit applies to male, female, and nonbinary members.
3. Effective Date of Change
Effective January 1, 2021, or as plans renew, for all other plans.
Tumor Necrosis Factor (TNF) Inhibitor New Prior Authorization (PA)
A new PA will be implemented for all new starts of outpatient TNFs (Enbrel, Humira, Cimzia, Simponi) starting 2/16/21
- Patients currently on a TNF will be grandfathered and will continue their medication without interruption
- Complete Medication Request Form to request coverage for medication
- Note: Dermatology PA encourages the use of home phototherapy. Kaiser Permanente contracts with Daavlin
- Submit order to Daavlin and they will work with the patient directly and help coordinate insurance coverage, billing, shipping, and technical support if needed.
- Daavlin phone: 1-800-322-8546
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.
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.