Kaiser Permanente is a leading integrated managed care consortium in the USA. It provides care and coverage for more than 12.5 million members. Here is the network’s overview in numbers:
- 25,270 physicians and 73,283 nurses.
- 40 hospitals and 612 medical offices.
Are you a healthcare provider or a facility struggling to join this massive network? If yes, this guide discusses the Kaiser Permanente credentialing process to help ensure a smooth journey toward partnership.
So, without further ado, let’s
Kaiser Permanente Credentialing Application Guidelines
The insurance company provides care services to its members across multiple locations in the USA. These include California (northern), California (southern), Colorado, Georgia, Hawaii, Maryland, Virginia, Washington D.C., Oregon, and Washington.
Note that the Kaiser Permanente credentialing application process slightly varies across these regions. However, we will only discuss how to request an application in Washington for simplicity.
Step 1: Complete the Application
You must complete the Washington practitioner application (WPA) to initiate the Kaiser Permanente provider credentialing process. You can submit your application via the Council for Affordable Quality Healthcare (CAQH) ProView platform.
Step 2: Choose a Specific Kaiser Foundation Health Plan
Once your application is complete, you must select ‘Kaiser Foundation Health Plan, Washington Region’ with the CAQH platform. It is an integral step to ensure the insurance company has access to your Kaiser Permanente credentialing application.
Step 3: Application Review
At this stage, the provider services department of Kaiser will review your application and forward it to the credentialing department for further processing.
Step 4: Credentialing Committee Approval
Kaiser’s credentialing committee will then review the application request and decide whether to approve it or not.
Step 5: Notification and Approval
Kaiser will send you a written notification if your application gets approved, and the contracting process will begin. In case you do not receive any notification, you have the right to request an update on your Kaiser Permanente credentialing application status.
Kaiser Permanente Provider Credentialing Requirements
Here, let’s understand the credentialing requirements for healthcare providers and facilities:
For Healthcare Practitioners
Are you a physician, physical, occupational, or speech therapist, or other qualified healthcare professional? You must fulfill the following requirements to ensure successful Kaiser Permanente healthcare provider enrollment:
Required Documentation
- Any additional brochures or attachments that support the application.
- Disclosure of Ownership and Control Information form that is attached to the Kaiser Permanente credentialing application.
- W-9 form to confirm your name, address, and taxpayer identification number (TIN).
General & Professional Information
- A list of foreign languages spoken by you.
- Details on whether the group practice is exclusively in a hospital setting, and a list of hospital affiliations (if any).
- Group or practice name, federal tax ID number, National Provider Identifier (NPI), and contact information, including name, address, phone, and email.
- Primary specialties, subspecialties, and age group of the patients you treat.
- State whether or not you are Medicare-certified, Medicaid-certified (state-specific).
Legal & Compliance Requirement
- Detailed demographic information along with a list of practice locations.
- Details on any individual with a 5% or more ownership or controlling interest in the practice. This section also requires a disclosure of any past health-related criminal offenses or legal actions.
- Statement ensuring that your provider information is updated and current on the CAQH profile to ensure timely Kaiser Permanente credentialing.
- As an applying healthcare provider, you must sign the form and mention the date.
For Organizational Providers
Discussed below are the Kaiser Permanente credentialing requirements for healthcare facilities:
Required Documentation
- Accreditation certificates.
- Addiction and Recovery Treatment Services (ARTS) attestation form, Department of Behavioral Health and Developmental Services (DBHDS) license, and staff roster (if applicable).
- Copy of your last state or Medicare survey (if you are not accredited).
- Professional and general insurance liability certificates.
- W-9 form to confirm the healthcare organization’s TIN.
Facility & Demographic Information
- Contact person name, title, phone, and email address.
- Facility name, address, phone number, fax number, and federal tax ID number.
- Type of your organization, i.e., whether the applying entity is a hospital, clinic, skilled nursing facility (SNF), etc.
Licensure & Certification
- License type, number, and expiration date. You must also disclose if any action has been taken against your license in the past.
- Participation status for Medicare certification, certification number, and last survey date. You must also attest whether your certification is in good standing and if it has ever been suspended or denied in the past.
- Status of Joint Commission or other accreditation, including the last survey date.
Financial & Attestation
- Name of the professional and general liability insurance carriers, policy numbers, coverage levels, and dates.
- Signature by an authorized officer attesting to the accuracy, validity, and completeness of all information.
Challenges in Getting Credentialed with Kaiser Permanente
We understand that the credentialing process can be lengthy and frustrating. However, understanding the common roadblocks can help you plan your journey towards getting credentialed with it without delay.
Regional Application Variations
The process for credentialing with Kaiser Permanente has significant regional autonomy. That is, the credentialing form, specific requirements, and even the portal can differ from one state to another.
As a result, the lack of standardization may overwhelm healthcare practitioners, especially those licensed in multiple states.
Reliance on CAQH Profile
If your CAQH profile has Inaccurate, outdated, or missing information, it can delay the credentialing process. The reason? Kaiser Permanente heavily relies on the CAQH database. Thus, any unexplained gap in your professional history or a single expired license can halt the process.
Peer Review and Committee Approval
Note that the credentialing committee at Kaiser Permanente comprises peer physicians. These individuals are responsible for conducting a thorough review of the applying provider’s qualifications. It involves a detailed evaluation of your practice patterns, professional conduct, and clinical competence.
This step may seem unjust to some applicants since it lacks transparency. Simply put, there is no way to review the specific peer references or protected materials used in this step. Thus, it adds a layer of uncertainty to the Kaiser Permanente insurance credentialing process.
Strict Documentation Requirements
The rigid documentation requirement further adds to the complexities of getting credentialed with Kaiser Permanente. You need to submit certificates, licenses, malpractice insurance, and a detailed professional history. However, any inaccuracies in these can also lead to delays and rejections.
Background and Reference Check
The insurance company conducts a thorough primary source verification and background checks. Thus, if they find any discrepancies, such as issues with professional references or any criminal record, you can encounter delays and even rejection of the Kaiser Permanente credentialing application.
Best Practices for Kaiser Permanente Insurance Credentialing
Now that you know what factors can stall your credentialing application, it is time to review a few best practices to get a better footing before requesting participation in the Kaiser Permanente network.
Maintain Your CAQH Profile
One of the key steps in ensuring a successful credentialing with Kaiser Permanente is to keep your CAQH profile complete and updated. Treat it like a master application. Why? Because the credentialing committee will rely on the CAQH database while reviewing your application request.
Thus, ensure that all information in your CAQH profile is up-to-date and accurate. Besides, we recommend that you re-attest it every 120 days. Additionally, you should update your resume in a month/year format to prevent delays due to discrepancies.
Organize Necessary Documentation
Organizing documentation before starting the credentialing process can save you time, effort, and potential errors. Thus, start by creating a physical and digital folder of all required documents. These include your DEA and CDS forms, licenses, board certifications, updated resume, and malpractice insurance.
Provide Supporting Attachments
Undoubtedly, the CAQH profile serves as the core of your Kaiser Permanente provider credentialing application. However, the insurance company welcomes you to provide any additional supporting documentation to support your application.
These may include a detailed list of your services or a professional brochure to help the credentialing committee during the assessment process.
Follow Up Proactively
You should strive to follow up with the regional provider services team at Kaiser Permanente every two to four weeks. Moreover, keep a record of the conversation for future reference.
Seamless Kaiser Permanente Credentialing with MediBillMD
Hopefully, this comprehensive guide will serve as a go-to resource whenever you plan to get credentialed with Kaiser Permanente. However, if you still find it challenging to pursue and follow through on your own, consider partnering with one of the best professional medical credentialing companies.
MediBillMD is one of the reliable companies offering insurance credentialing services to healthcare providers across all 50 states. Regardless of your specialty or practice size, our expert team has the knowledge and skills to navigate through the complexities of the Kaiser Permanente credentialing process.
