Authorization for Medical Care♦
Please fax completed form with supporting documentation to 877-800-5456. Pre-authorization requests must be submitted by a healthcare provider. If you have any questions about the pre-authorization request form, the pre-authorization process, or what services require pre-authorization, please call us at the phone number below. Kaiser Permanente NW Regional Referral Center: 503-813-4560 or 1-866-813-2437
Eligibility Verification Form♦
The Eligibility Verification Form is a template that can be used when provider offices need to verify the eligibility of numerous Kaiser Permanente Northwest members.
Explanation of Payment (EOP)♦
The Kaiser Permanente Explanation of Payment is sent to providers to inform them of how a claim was adjudicated.
Laboratory Requisition Form♦
Please use the attached form when ordering Laboratory Services from Kaiser Permanente.
For questions regarding Laboratory Services, contact Laboratory Client Services at 503-258-6900.
Specialty Radiology Form♦ and Radiology Form♦
Please use the attached forms when ordering Radiology Services from Kaiser Permanente.
Drug Coverage Request Form♦
Please prescribe formulary medication(s) for your patients with Kaiser Permanente benefits. To view our formulary, visit www.kp.org/formulary. If a formulary medication is not appropriate, complete the Drug Coverage Request Form and Fax to 1-866-618-6569
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