Kaiser Permanente Pre-Authorization Instructions
This form provides essential guidelines for obtaining pre-authorization for medical services with Kaiser Permanente. It details the required documentation and timeframes for processing requests. Follow the instructions carefully to ensure your request is handled promptly.
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How do I fill this out?
To fill out this form, start by entering your personal and patient information in the designated fields. Ensure all required supporting documents, such as clinical notes and diagnosis codes, are included. After completion, submit the form as directed to avoid any delays.
How to fill out the Kaiser Permanente Pre-Authorization Instructions?
1
Complete the personal and patient information at the top of the form.
2
Attach all necessary supporting documents including clinical notes.
3
Ensure you have the correct diagnosis and procedure codes.
4
Double-check the form for completeness before submission.
5
Fax the completed form to the appropriate number provided.
Who needs the Kaiser Permanente Pre-Authorization Instructions?
1
Patients requiring pre-authorization for elective surgery.
2
Healthcare providers submitting requests on behalf of patients.
3
Insurance coordinators managing patient authorization processes.
4
Administrative staff ensuring compliance with healthcare regulations.
5
Mental health providers needing authorization for certain therapies.
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What are the instructions for submitting this form?
Submit the completed Kaiser Permanente pre-authorization form by faxing it to 877-800-5456. Ensure that all required fields are filled accurately and attach any necessary supporting documentation. If you have questions regarding the submission process, contact the Regional Referral Center at 503-813-1031 or 1-855-281-1840 for clarification.
What are the important dates for this form in 2024 and 2025?
For 2024 and 2025, maintain a timeline to submit forms two business days prior to scheduled procedures. Stay aware of any changes in Kaiser Permanente's policies regarding pre-authorization processes. Consult specific dates and deadlines often to avoid delays.
What is the purpose of this form?
The purpose of the Kaiser Permanente pre-authorization form is to facilitate the authorization process for medical services. It streamlines the collection of necessary information and supporting documents required by the review teams. By providing a standardized form, it ensures that requests are processed efficiently and accurately.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Information: Includes fields for patient name, date of birth, and Medical Record Number.
- 2. Requesting Provider/Physician: Details about the physician initiating the request, including NPI and contact information.
- 3. Place of Service: Information about where the service will be rendered including address and provider details.
- 4. Service Requested: Describes the specific medical service or procedure being requested.
- 5. Additional Information: Any extra notes or instructions relevant to the authorization request.
What happens if I fail to submit this form?
Failure to submit this form may result in delays in receiving necessary medical services. Incomplete or incorrect submissions will not be processed, leading to potential denial of the request. It's critical to ensure all required information is provided.
- Service Delays: If the form is not submitted correctly, patients may face delays in receiving treatment.
- Denial of Authorization: Incomplete forms can lead to outright denial of the service request.
- Increased Administrative Burden: Incorrect submissions necessitate further communication and work, burdening staff.
How do I know when to use this form?
- 1. Elective Surgeries: Use this form when requesting pre-authorization for planned surgical procedures.
- 2. Specialist Consultations: Needed when a patient is referred to a specialist for additional care.
- 3. Diagnostic Imaging: Required for specific imaging services that may need prior approval.
- 4. Mental Health Services: Necessary for therapy services that require authorization from insurers.
- 5. Laboratory Services: Use this for specialized or extensive laboratory tests that need pre-approval.
Frequently Asked Questions
How do I access the pre-authorization form?
You can access the pre-authorization form directly on our PrintFriendly platform.
What documents do I need to submit with the form?
Ensure you include diagnosis codes and supporting clinical notes when submitting.
How long does it take to process the request?
Non-urgent requests typically take two business days to process.
Can I edit the PDF directly on PrintFriendly?
Yes, our platform allows for easy editing of PDF documents.
Where should I fax my completed form?
Fax the completed form to 877-800-5456.
Is there a deadline for submissions?
Submit your request at least two business days before your scheduled service.
Who can help if I have questions about the form?
Call the Kaiser Permanente NW Regional Referral Center for assistance.
Can I save the edited document?
Currently, you can download the edited files but not save them on the site.
What if I need to make changes after submitting?
Contact the referral center directly for any modifications once submitted.
How is the form used by healthcare providers?
Providers utilize the form to request necessary authorizations for patient care.
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