Kaiser Permanente at a glance
| Legal name | Kaiser Foundation Health Plan, Inc. |
|---|---|
| Also known as | KP, Kaiser |
| Category | Commercial |
| Parent organization | Kaiser Foundation Health Plan, Inc. |
| Claims payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| Eligibility (270/271) payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| ERA (835) payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for Kaiser Permanente. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
| NAIC company code | Not established in this registry |
| States covered | California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, District of Columbia |
| Members covered | ~13 million members |
| Provider resource entry point | https://healthy.kaiserpermanente.org/community-providers |
| Provider phone | Plan-specific |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for Kaiser Permanente
A single filing deadline has not been established for this Kaiser Permanente record. Check the member's plan, regional manual, provider agreement and applicable rules before calculating the deadline.
| Submission type | Window |
|---|---|
| Initial claim reference | Plan-, region- or contract-specific |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
Reconsideration and appeal routes
- Regional provider reconsiderationVerify deadline
Kaiser Permanente reconsideration deadlines are regional and contract-specific; verify the denial notice and regional provider manual before filing.
Source: Kaiser Permanente provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with Kaiser Permanente
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify Kaiser Permanente electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for Kaiser Permanente. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for Kaiser Permanente
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient Kaiser Permanente volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| 270 / 271 eligibility | Listed in registry; verify current scope | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for Kaiser Permanente. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
What revenue cycle teams should verify before submitting claims
- Confirm the member's Kaiser Permanente region before selecting any payer ID; Northern California, Southern California, Colorado, Georgia, Mid-Atlantic, Northwest, Hawaii, and Washington route differently.
- Use the member ID card, regional provider portal, and any single-case agreement to confirm claim address, timely filing, and appeal rights.
- For out-of-area emergency or authorized referral claims, capture the authorization number and host/home region details before submission.
Common denial and routing risks for this payer
- Routing a claim to the wrong Kaiser region or regional payer ID.
- Assuming a national timely filing window when the regional provider manual or contract controls.
- Submitting outside-provider services without the referral, emergency, or authorization context Kaiser requires.
How QuickIntell supports this workflow
- Use eligibility intake rules to capture Kaiser region, host/home identifiers, and referral status before claim creation.
- Route payer-ID selection through region-specific clearinghouse logic instead of a single national KP value.
- Attach authorization and referral evidence to claims that originate outside a Kaiser-owned delivery site.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
Regional routing
Source comparison: 2026-09-06
Kaiser's community-provider entry point asks users to select a geographic area. Retain regional routing rather than supplying one national provider phone or filing deadline.
Primary source for regional routingWashington manual scope
Source comparison: 2026-09-06
The Washington manual identifies contracted Washington providers as its audience and says provider contracts and legal requirements control inconsistencies. It is not a national Kaiser manual.
Primary source for washington manual scopetimely_filing_days, filing_rule, provider_phone
Source comparison: 2026-09-18
Washington-only product distinctions, 12-month calendar units and self-funded exceptions; 30-day submission request is not maximum deadline. Source locator: Section 6.2.22; printed pp 73–75/PDF pp 82–84. Document/version: June 15, 2026 cover.
Primary source for timely_filing_days, filing_rule, provider_phone
Not checked in this pass: Each region's filing and appeal deadlines; Enrollment totals; Payer IDs and transaction support; QuickIntell outcomes; All fields outside these bounded findings, including exact legal entity/NAIC, current enrollment and geography; Product-complete initial, corrected, secondary and appeal rules, agreements, exceptions and effective dates; Every claims, eligibility, ERA and authorization transaction identifier; portal access is not capability certification; Current clinical criteria and prior-authorization code samples; QuickIntell integrations/outcomes and historical DataForSEO demand; Accountable whole-record editorial approval; no last_reviewed date was advanced.
Sources used for this guide
State coverage
Kaiser Permanente operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
Evaluate QuickIntell workflow fit for Kaiser Permanente
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for Kaiser Permanente; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for Kaiser Permanente; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for Kaiser Permanente before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about Kaiser Permanente
Where is the Kaiser Permanente provider portal?
Use https://healthy.kaiserpermanente.org/community-providers as a starting point for Kaiser Permanente provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for Kaiser Permanente?
A single filing deadline has not been established for this Kaiser Permanente record. Check the member's plan, regional manual, provider agreement and applicable rules before calculating the deadline.
Does Kaiser Permanente publish a single claims payer ID?
This registry has not established one all-product claims payer ID for Kaiser Permanente. See the source findings for transaction-specific references. Look up the correct ID for the member's plan and transaction in your clearinghouse directory and verify against the member ID card before submission.
Does Kaiser Permanente accept electronic claims?
Verify Kaiser Permanente electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a Kaiser Permanente denial?
Identify the product, state and reason for the decision before choosing a Kaiser Permanente dispute route. The listed starting route is Regional provider reconsideration (Verify deadline). Kaiser Permanente reconsideration deadlines are regional and contract-specific; verify the denial notice and regional provider manual before filing. Verify the controlling notice and exceptions; reconsideration, appeal and external review are not always a mandatory sequence.
How long do Kaiser Permanente prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
How do providers contact Kaiser Permanente?
This registry has not established one provider phone number for Kaiser Permanente. This registry has not established one national provider-services phone number for Kaiser Permanente. Use the provider portal or member ID card for plan-specific phone routing. Use https://healthy.kaiserpermanente.org/community-providers as a starting point for Kaiser Permanente provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
For revenue-cycle teams
Connect payer lookups to your revenue-cycle workflow
Do staff repeatedly move between payer references, eligibility checks, claim status and remittance follow-up?
- Keep this payer's official reference available to the team.
- Identify one repeated administrative task and measure its handling time.
- Evaluate the required access, exceptions and reviewer handoff before expanding automation.
Kaiser Permanente is an operational reference. Payer decisions remain with the payer. Confirm plan coverage, system access and supported actions during a scoped evaluation.
Download the illustrative workflow worksheet (PDF) · Explore the AI RCM evaluation toolkit · Model the workload and costs
Automate workflows around Kaiser Permanente requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against Kaiser Permanente's current published documents before submission. CPT® is a registered trademark of the American Medical Association.