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News and anouncements

COVID-19
VA Medicaid Lunch & Learn December 9, 2021
VA Medicaid ER Payment Reductions and Hospital Readmissions
Introducing Changes Coming to KP Online Affiliate Claims Section
New Provider Email Contacts at KP
UMOC Fax Number Changes
Virginia Premier Kaiser Permanente Medicaid Program
Diversity
New Kaiser Permanente HealthConnect AffiliateLink Enrollment System
Provider Referral Requests
KP HealthConnect Affiliatelink

COVID-19

We are working to address questions and concerns you have. Please see the below FAQs and reference guide to assist you with providing critical care to our members. We will continue to keep you informed as the situation evolves.

COVID-19 FAQ – updated 7/12/2021

COVID-19 Claims FAQ – updated 11/30/2021

COVID-19 KPIC Claims FAQ– updated 5/5/2021

COVID-19 Coding Quick Reference Guide – updated 1/22/2021

Telehealth Talking Points

Telehealth Guide – updated 3/10/2022

Medicare Telehealth FAQ

COVID-19 Vaccine FAQ – updated 11/30/2021

COVID-19 KPIC Vaccine FAQ– updated 5/5/2021

MDH COVID-19 #1

MDH COVID-19 #12 Temporary Registration of RBT - expired August 15, 2021

DC Health Vaccine Counseling

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4th Quarter 2021 Kaiser Permanente Virginia Medicaid Provider Virtual Lunch and Learn

On Thursday, December 9, 2021 we held our first quarterly forum just for VA Medicaid providers.

Topics included:

  • What’s new at Kaiser Permanente
  • DMAS’ Behavioral Health enhancements
  • Online Affiliate and its features
  • Telehealth guidelines
  • The SafeLink smartphone program

Click here to see the information discussed in the forum.

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Emergency Room Reductions and Hospital Readmissions

The Virginia Department of Medical Assistance Services (DMAS) has issued a bulletin, Reimbursement Reductions for Preventable Emergency Room Visits and Hospital Readmissions, which communicates changes to the reimbursement structure of such claims. These changes will become retroactively effective as of July 1, 2020. For details of the changes, see the notice below.

ER Payment Reductions and Hospital Readmission Notice

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Introducing Changes Coming to KP Online Affiliate Claims Section

We are excited to inform you of a few new updates coming Saturday, August 8, 2020 to the Kaiser Permanente Online Affiliate.

We are committed to continually improving the online capabilities for our external providers, and the upcoming changes will allow you to easily view specific claim detailed information.

These changes will introduce the following to the claims detail report:

  • A brand new look and feel of the claims details report
  • Claim related referrals and diagnosis information have been added
  • Provider/vendor address on Claim submission will be viewable

Please see our job aid to make it easier for you to get comfortable with the new look.

Please reach out to your regional Online Affiliate representative should you have any questions.

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New Provider Email Contacts at KP

Effective January 1, 2020, we’re making some updates to where information should be sent to us so that we can serve you better and ensure that inquiries are going directly to those that will handle them.

Ensuring that your message is sent to the correct email address or that your call is placed to the correct phone number allows us to respond quickly and serve you better.

The below list provides updated contacts at Kaiser Permanente for participating network providers.

You may begin to use the new contacts on January 1, 2020. If you’re unsure about who to contact for an issue, contact Provider Relations at provider.relations@kp.org or 877-806-7470 for assistance.


Provider Experience

Email: provider.relations@kp.org 

Phone: 
877-806-7470

  • Claims payment questions
  • Billing questions
  • Provider form/orientation requests
  • Online Affiliate inquiries

Member Services

Phone:
800-810-4766

  • Check claims status and general claims payment
  • Member eligibility and benefit verification
  • Members needing care who don't have a Kaiser Permanente identification card
  • ERA/EFT status
  • Provider itemized bill questions
  • Provider appeal inquires

Provider Demographic Updates

Email: provider.demographics@kp.org

  • Provider addition and termination requests
  • Provider status update requests
  • Provider demographic changes (i.e., name, practice locations, phone number, fax number, specialty update, etc.)

Utilization Management

Phone:
800-810-4766

  • Referral management and pre-certification
  • Emergency care recordation
  • Inpatient care authorization
  • Case management and concurrent review

Interested Providers

Email: interested.providers@kp.org

  • Apply to contract with Kaiser Permanente
  • Status updates on applications
  • Send initial credentialing applications

Provider Recredentialing

Email:
ppqa-mas@kp.org

  • Send recredentialing applications

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UMOC Fax Number Changes

In an effort to streamline our referral process and improve timelines of requests, the Utilization Management Operations Center (UMOC) has made some adjustments to fax numbers for certain specialty services. All fax numbers previously communicated have not been changed and are currently in operation but have been re-assigned based on the type of referral requested. The chart outlines the service type, old fax number and new.


Referral Type Old fax number New fax number
Durable Medical Equipment (new URF referrals) 855-414-1695 800-660-2019
Durable Medical Equipment (reauthorizations - add codes to update existing referral) 855-414-1695 855-414-1695
All Physical Therapy/Occupational Therapy/Speech Therapy (PT/OT/ST) (new URF referrals) 855-414-1695 800-660-2019
Skilled Nursing Facility PT/OT/ST (reauthorizations) 855-414-1695 855-414-1698
Outpatient Rehab PT/OT/ST (reauthorizations) 855-414-1698 855-414-1698
Home Health PT/OT/ST (reauthorizations) no existing fax number 855-414-1695
Early Intervention no existing fax number 855-414-1695

 

These changes will go into effect on June 20, 2019. We have updated our training materials and provider manuals to reflect these changes. If you have additional questions, you can email us at Provider.Relations@kp.org or call us at 800-777-7902.

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Virginia Premier Kaiser Permanente Medicaid Program

Kaiser Permanente's mission is to provide high-quality, affordable health care services to people throughout the region and achieve our goal of increasing our region’s membership to 1.3 million members. Today, we provide coverage and care in Northern Virginia to 15,400 Medicaid members. Consistent with our mission, and despite the Commonwealth's consolidation of Medicaid managed care organizations, we intend to continue to care for current and newly eligible Medicaid members. With the Commonwealth’s upcoming expansion of Medicaid, it's estimated that 400,000 more people residing throughout Virginia will become eligible for Medicaid coverage in 2019.

To remain consistent with our mission of providing high quality, affordable health care services to our members and the communities we serve, Kaiser Permanente has entered into an innovative collaboration with Virginia Premier, the second largest Medicaid managed care organization in Virginia, to create a fully integrated health care experience.

Unless members choose otherwise, starting October 1, 2018, current Kaiser Permanente Medicaid members will continue to receive Kaiser Permanente’s integrated health care, just as they do today. Additionally, we will work with Virginia Premier to attract new Virginia members and patients beginning January 1, 2019.

What does this mean?

Kaiser Permanente Virginia Medicaid members will continue to receive the same high-quality health care. Members will retain their current Kaiser Permanente PCP. Participating providers should continue to obtain necessary referrals and authorizations through the same channels. All approved authorizations that extend beyond the transition date of October 1, 2018 will remain valid for approved dates and visits. Claims should still be sent to:

Mid-Atlantic Claims Administration
Kaiser Permanente
P.O. Box 371860
Denver, CO 80237-9998

Current and new members will receive a new co-branded Virginia Premier – Kaiser Permanente ID card.

The Virginia Premier Kaiser Permanente Medicaid Program Provider Manual will replace the Kaiser Permanente Virginia Medicaid and FAMIS Provider Manual and will be updated to entail our new partnership with Virginia Premier.

For further questions, providers and members may contact Kaiser Permanente Member Services at 855-249-5025, Monday through Friday, 7:30 A.M. to 9 P.M.

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Diversity

Members have the right to free language services for health care needs. We provide free language services including:

  • 24-hour access to an interpreter: When members call to make an appointment or talk to their personal physician, if needed, we will connect them to a telephonic interpreter.
  • Translation services: Some member materials are available in the member’s preferred language.
  • Bilingual physicians and staff: In some medical centers and facilities, we have bilingual physicians and staff to assist members with their health care needs. They can call Member Services or search online in the medical staff directory at kaiserpermanente.org.
  • Braille or large print: Blind or vision impaired members can request for documents in Braille or large print or in audio format.
  • Telecommunications Relay Service (TRS): If members are deaf, hard of hearing, or speech impaired, we have the Telecommunications Relay Service (TRS) access numbers that they can use to make an appointment or talk with an advice nurse or member services representative or with you.
  • Sign language interpreter services: These services are available for appointments. In general, advance notice of two or three business days is required to arrange for a sign language interpreter; availability cannot be guaranteed without sufficient notice.
  • Educational materials: Health education materials can be made available in languages other than English by request. To access Spanish language information and many educational resources go to kp.org/espanol or kp.org to access La Guía en Español (the Guide in Spanish). Members can also look for the ñ symbol on the English language Web page. The ñ points to relevant Spanish content available in La Guía en Español.
  • Prescription labels: Upon request, the KPMAS pharmacist can provide prescription labels in Spanish for most medications filled at the Kaiser Permanente Pharmacy.

At Kaiser Permanente, we are committed to providing quality health care to our members regardless of their race, ethnic background or language preference. Efforts are being made to collect race, ethnicity and language data through our electronic medical record system, HealthConnect®. We believe that by understanding our members’ cultural and language preferences, we can more easily customize our care delivery and Health Plan services to meet our members’ specific needs.

Currently, when visiting a medical center, members should be asked for their demographic information. It is entirely the member’s choice whether to provide us with demographic information. The information is confidential and will be used only to improve the quality of care. The information will also enable us to respond to required reporting regulations that ensure nondiscrimination in the delivery of health care.

We are seeking support from our practitioners and providers to assist us with the member demographic data collection initiative. We would appreciate your support with the data collection by asking that you and your staff check the member’s medical record to ensure the member demographic data is being captured. If the data is not captured, please take the time to collect this data from the member. The amount of time needed to collect this data is minimal and only needs to be collected once. Recommendation for best practices for collecting data is during the rooming procedure.

In conclusion, research has shown that medical treatment is more effective when the patient’s race, ethnicity and primary language are considered.

To access organization wide population data on language and race, please see our Diversity & Inclusion Annual Report*.

To obtain your practice level data on language and race, please email the Provider Relations Department at Provider.Relations@kp.org.

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Provider Referral Requests

The Kaiser Permanente Utilization Management Operations Center reviews each referral request and determines the number of visits that are medically necessary.  When requesting referrals, please only request one visit or the exact number of visits that will be needed for a three (3) month period. 

Additional visits can be added if medically necessary before approval but if more visits are requested than needed the member will receive a partial approval/denial letter which has been creating confusion for members as they believe their referral is being denied.  To help avoid this, please only request one visit or the exact number of visits necessary.

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New Kaiser Permanente HealthConnect AffiliateLink Enrollment System

A new automated Kaiser Permanente HealthConnect AffiliateLink enrollment system was implemented in Spring 2015. With the new automated enrollment system, new users are able to apply online and receive their user ID and password electronically. It will no longer be necessary to submit paper enrollment forms. The new online enrollment system provides greater security measures that will help protect our members’ health information.

Before the new enrollment system was launched, it was necessary that we migrate all current user information into the new system. Current users were sent a revised enrollment form to be completed with the necessary information. If you did not receive the revised enrollment form*, you may print, complete, and fax it to 855-414-2624.

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KP HealthConnect Affiliatelink

Browser, system, and connection requirements have been updated.
The following Internet browsers are required for access AffiliateLink:

  • Microsoft® Internet Explorer® 8.0, 9.0, 10, 11.
  • Mozilla Firefox™ 10.0 or later.
  • Apple Safari Google Chrome.

While other browsers and operating systems may work with our secure features, we cannot guarantee compatibility.

Renewing your annual subscription
In order to maintain the most secure and confidential care possible, we require that you annually renew your participation. As a part of the KP HealthConnect AffiliateLink User Access Compliance Review Process, the Provider Experience Department will send a survey to ensure that you still need to use the website and have the correct level of access.

Please note:
If you do not access the system for any consecutive 90 days, your account will be deactivated. Deactivated users will need to contact Provider Experience at 1-877-806-7470 to be reactivated.

Password Protection
Password protection is only as secure as the password that you choose. It is imperative that all users have their own individual sign-on and password. Please do not share logins or passwords.

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