Billing and Claims for Visiting Members from other Kaiser Permanente Regions

Members of other Kaiser Permanente regions may receive care in any of our clinics or by one of our contracted providers in the Kaiser Permanente Washington region (KPWA). Visiting members are subject to the same business practices and prior authorization rules as in the KPWA Core plan.

If you have any questions regarding the Visiting Member process, such as member set-up, billing, or benefit questions, contact the Visiting Member Unit toll-free at 1-800-446-4296 or 509-241-7798. For prior-authorization questions, contact Review Services at 1-800-289-1363.

When seeing a visiting member for the first time, you must verify if the member has coverage set up in the Kaiser Permanente Washington system. If the visiting member does not have a member ID number, contact the Visiting Member department to have them verify eligibility and to have a member number assigned.

You must find out which Kaiser Permanente region the member is from to determine the benefit coverage. Be prepared to furnish the following information:

  • Member's last name, first name, middle initial
  • Date of birth
  • Kaiser home plan name and ID number
  • Social Security Number

Submit all claims to:

Kaiser Permanente
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 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 Kaiser Permanente home plan directly.

For all services other than pharmacy, bill directly to KPWA for visiting members. Do not collect any copayments; we will pay you for services per your contract terms, including any member cost shares.

Hospice Claims

A provider who receives prior authorization from the Kaiser Permanente Hospice Program should submit the claim to:

Kaiser Permanente Hospice Program
201 16th Ave. E., CMB-C140
Seattle, WA 98112-5211

Reviewed 6/13/2017

The Provider Manual is not intended for any use by any party other than as a resource for Kaiser Foundation Health Plan of Washington's contracted providers in fulfilling their obligations under provider contracts. Kaiser Permanente intends for the manual to be accurate for its intended purpose but doesn’t 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.