Billing and Claims for Kaiser Permanente Members
Kaiser Permanente members' benefits allow them to be treated in any of our clinics or by one of our contracted providers in our service areas. The Kaiser Permanente member is subject to the same business practices and prior authorization policies as a Group Health member.
If you have any questions regarding the Visiting Member process or have a Kaiser Permanente member to set up, contact the Visiting Member Unit toll-free at 1-800-446-4296 or 509-241-7798. For billing and benefits questions, contact the Provider Assistance Unit (PAU). For prior-authorization questions, contact Review Services.
When seeing a Kaiser member for the first time, you must verify if the member has coverage set up in the Group Health system. If the Kaiser member does not have a Group Health member ID number, contact the Visiting Member department to verify benefits and eligibility and to have a member number assigned.
You must find out which Kaiser region the member is from to determine the benefit coverage. Be prepared to furnish the following information:
Submit all claims to:Group Health Cooperative
Attn: Visiting Members
P.O. Box 34585
Seattle, WA 98124-1585
We will review each claim for benefit coverage. If we deny a claim, we will notify the member and provider. Lack of prior authorization may result in delay or denial of payment.
Pharmacy services are the only services for which you should collect a copayment. To verify eligibility and pharmacy benefits, contact the Provider Assistance Unit (PAU).
For all services other than pharmacy, bill Group Health directly for Kaiser Permanente members. Do not collect any copayments; we will pay you for services per your contract terms, including any member cost shares.
A provider who receives prior authorization from the Group Health Hospice Program should submit the claim to:Group Health Hospice Program
201 16th Ave. E., CMB-C140
Seattle, WA 98112-5211
The Provider Manual is not intended for any use by any party other than as a resource for Group Health Cooperative's contracted providers in fulfilling their obligations under provider contracts. Group Health intends for the manual to be accurate for its intended purpose but doesnt guarantee accuracy. Providers should comply with the terms of their provider contracts and any legal requirements in the event of an inconsistency between the manual and a requirement in their provider contracts or the law.