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Authorization policies

View and submit referrals
Referred specialty care
Case Management Services

View and submit referrals

You can view and submit referrals by signing on to our provider tools*.

A referral is defined as sending a member for office-based professional services. Referrals are required for all specialties other than dermatology, ob-gyn, ophthalmology, optometry, and outpatient behavioral health. Other services (including routine radiology, lab, etc.) do not require a referral. See Section 4.5 of the Provider Manual* for further clarification.

Primary care physicians should generate referrals via KP Online-Affiliate when referring members to specialists or the claims will deny. Specialists need to verify referrals are in KP Online-Affiliate. If there is no referral in the system, contact the primary care office.

We will no longer be providing paper referral grids. You will get that information from KP Online-Affiliate. Kaiser Permanente expects referring physicians to supply all pertinent diagnosis and clinical information to the specialist via the online request for the referral.

Please call the Kaiser Permanente QRM Intake Services department at 404-364-7320 or 800-221-2412 (toll-free) for assistance when referring a Kaiser Permanente member for specialty care.

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Referred specialty care

Referred specialty care services are coordinated by the member's personal physician, which includes care that members receive in the hospital or from specialists.

Patients look to their personal physician for guidance when they need to see a specialist. Often, the personal physician has an established relationship with a specific group of specialty care providers, improving coordination of care. When patients need specialty care, we encourage physicians to talk to them about the numerous benefits of seeing a Kaiser Permanente specialist. We have provided the TSPMG Specialty Care Guide* for you to share with members.

Primary care physicians should generate referrals via KP Online-Affiliate. The member's personal physician will advise if the referral requires authorization from authorization.

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