Transplant Provider Manual Kaiser Permanente Self-Funded Program
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1 Transplant Provider Manual Kaiser Permanente Self-Funded Program Key Contacts
2 Table of Contents 2 SECTION 2: KEY CONTACTS NATIONAL TRANSPLANT NETWORK ADMINISTRATION CENTRAL EAST HUB NORTHERN CALIFORNIA AND NORTHWEST HUB SOUTHERN CALIFORNIA AND HAWAII HUB NATIONAL PROVIDER CONTRACTING AND NETWORK MANAGEMENT SELF FUNDED CUSTOMER SERVICE IVR SYSTEM WEBSITE
3 2 Below are key contacts for Self-Funded Member inquiries. Department Contact information Type of Help or Information from this Department Self-Funded Customer Service Provider Contracting & Network Management Department Kaiser Permanente National Transplant Network Hubs Customer Service Representatives are available Monday through Friday 7 a.m. to 9 p.m. Eastern Time Zone Self-Service IVR System available: 24 hours / 7 days a week Phone: Fax: Website available: 24 hours / 7 days a week A representative from Provider Contracting & Network Management Department is available Monday through Friday 8 a.m. to 5 p.m Pacific Time Zone Phone: (510) Fax: (510) Transplant referrals are managed from three National Transplant Network Hubs. Please see contact list for the National Transplant Administrative Offices and Hubs on pages Northern California/ Northwest Hub Southern California/Hawaii Hub Central East Hub (Colorado, Georgia, Mid-Atlantic States) 1. General enrollment questions 2. Eligibility and benefit verification 3. Claims management 4. Billing and payment inquiries 5. EDI questions 6. Appeal and claims dispute questions 7. Co-pay, deductible and coinsurance information 8. Members terminated greater than 90 days 9. Members presenting with no Kaiser Permanente identification number 10. Send Provider demographic updates such as Tax ID changes, address changes here 11. Send information regarding practitioner additions or terminations from your office here 12. Provider education and training 13. Contract questions 14. Contracted rate payment questions 15. Form requests 16. Issues and problem solving 17. Obtain pre-certification for services and admissions (if online services are unavailable) 18. DME and Home Health referrals 19. Emergency Department notifications 20. All inpatient admissions 21. Transfers to Skilled Nursing Facilities (SNF) 22. Ambulance Transports 23. Discharge planning, case management 3
4 2.1 National Transplant Network Administration Director, National Transplant Network Christy Edwards 1800 Harrison St., 18th Floor Tel: (510) Fax: (510) Quality Improvement Manager Eileen Thompson, RN D Bournefield Way Silver Spring, MD Tel: (301) Central East Hub Manager Celia D. Clarke, RN D Bournefield Way Silver Spring, MD Tel: (301) ; Northern California Hub Manager Kenni Bishop, RN 1800 Harrison Street, 9th Floor Tel: (510) Executive Assistant Mary E. Landry 1800 Harrison Street, 18th Floor Tel: (510) Fax: (510) Administrative Assistant Gena Agustin-Millare 1800 Harrison Street, 18th Floor Tel: (510) Fax: (510) Travel Coordinator Peggy Cohen-Lovecchio D Bournefield Way Silver Spring, MD Tel: (301) Quality Improvement Coordinator Joycelyn C. O mard D Bournefield Way Silver Spring, MD Tel: (301) Joycelyn.c.o mard@kp.org Southern California Hub Manager Malou A. Valencia, RN 4733 Sunset Boulevard, 2nd Floor Los Angeles, CA Tel: (323) Fax: (323) Malou.a.valencia@kp.org Communication And Training Manager Gordon Loo 1800 Harrison Street, 18th Floor Tel: (510) Fax: (510) Gordon.loo@kp.org 4
5 2.2 Central East Hub Mailing Address: D Bournefield Way, Silver Spring, MD (800) On Call Pager: (888) or (888) Medical Director To be determined Tel: (301) Pgr: (877) or (800) Hub Manager Celia D. Clarke, RN Tel: (301) Quality Improvement Manager Eileen Thompson, RN Tel: (301) Cell: (301) Quality Improvement Coordinator Jocelyn C. O Mard Tel: (301) joycelyn.c.omard@kp.org Transplant Coordinators Veronique L. Carrillo, RN Transplant Coordinator: Renal Tel: (301) veronique.l.carrillo@kp.org Susan Fleagle, RN Transplant Coordinator: OH/GA Tel: (301) susan.fleagle@kp.org Libbie Griffin, RN Transplant Coordinator: CO Tel: (301) libbie.griffin@kp.org Penny Keaney, RN BSN, MA Transplant Coordinator: MAS Tel: (301) penolope.h.keaney@kp.org Gloria Raizada, RN Transplant Coordinator: Renal Tel: (301) gloria.raizada@kp.org Cathy Wells, RN, BSN, OCN Transplant Coordinator, MAS Tel: (301) cathy.l.wells@kp.org Kesha Levesque, RN, BSN Transplant Coordinator: MAS Renal Tel: (301) kasha.levesque@kp.org Clinical Associates Tiffany Abney Tel: (301) tiffany.w.abney@kp.org Gail Fisher-Francis Tel: (301) gail.fisher@kp.org Travel Coordinator Peggy Cohen-Lovecchio Tel: (301) peggy.cohen@kp.org Data Analyst Nachi A. Mbinkar Tel: (301) nachi.a.mbinkar@kp.org Administrative Support Willietta Johnson-Williams Tel: (301) willietta.o.johnson-williams@kp.org Rajaa Elalami Tel: (301)
6 2.3 Northern California and Northwest Hub Mailing Address: 1800 Harrison St. 9th Floor, On Call Coordinator: (888) or (510) Medical Director MaryPat Pauly, MD 2025 Morse Avenue Sacramento, CA Tel: (916) Fax: (916) Pgr: (916) Hub Manager Kenni Bishop, RN Tel: (510) Fax: (510) Cell: (510) Transplant Coordinators Carmel Wilcox, RN BMT Coordinator: (A-E) Tel: (510) Patricia J. Murphy, RN BMT Coordinator: (F-N) Tel: (510) Barbara Abernathy, RN BMT Coordinator: (O-Z) Tel: (510) Martina Martinez, RN Liver Coordinator: (A-E) Tel: (510) Adele Alcocer, RN Liver Coordinator (F-L) Tel: (510) Constance Glenn, RN Liver Coordinator (M-R) Tel: (510) Linda Mack, RN Liver Coordinator (S-Z) Tel: Fax: Linda Grams, RN Lung, Heart-Lung Coordinator Tel: (510) Fax: (510) Sharlene Junio, RN Heart Coordinator 710 Lawrence Express Way Santa Clara, CA Tel: (408) Fax: (408) (Linda) Sue Murray, RN Heart Coordinator 710 Lawrence Express Way Santa Clara, CA Tel: (408) Fax: (408) Marilyn Riggs, RN Heart Coordinator 710 Lawrence Express Way Santa Clara, CA Tel: (408) Fax: (408) Transplant Clinical Associate Debbie Blake Tel: (510) Fax:(510) Chella Figueroa Tel: (510) Fax:(510) Data Analyst Alexis Heins Tel: (510) Fax:(510) Transplant Assistant Lionel Anderson Liver & Lung Transplant Assistant Tel: (510) Fax: (510) Liz Salk BMT Transplant Assistant Tel: (510) Fax:(510)
7 2.4 Southern California and Hawaii Hub Southern California Hub Mailing Address: 4733 Sunset Blvd., Los Angeles, CA Liver Transplant Program: 1526 N. Edgemont St. 7 th Fl., Los Angeles, CA Tel: (323) Bone Marrow Transplant Program: 1515 N. Vermont Avenue, 8 th Fl., Los Angeles, CA Tel: ( Fax: (323)-7266 Medical Director Neil M. Kogut, MD 1515 N. Vermont, 8 th Floor Los Angeles, CA Tel: (323) Pgr: (626) Fax: (323) neil.m.kogut@kp.org Hub Manager Malou A. Valencia, RN Tel: (323) Cell: Fax: (323) malou.a.valencia@kp.org Transplant Coordinators Riza Olbes, RN PAK & Hawaii Utilization Coordinator Tel: (323) Pgr: (800) Fax: (323) riza.m.olbes@kp.org Sue Miles, RN Lung and Heart/Lung Coordinator Tel: (323) Pgr: (800) Fax: (323) susan.x.miles@kp.org Kathy McAvoy-Jahraus, RN Heart Coordinator Tel: (323) Pgr: (310) Fax: (323) Kathy.a.mcavoy@kp.org Amalia P. Sanchez Liver Coordinator Tel: (323) Pgr: (800) amalia.p.sanchez@kp.org Teruye Kawahira-Musashi, RN Liver Coordinator (A-B & M-Q) Tel: (323) Pgr: (800) teruye.k.kawahira-musashi@kp.org Katherine A. Piscopo, RN Liver Coordinator Tel: (323) Pgr: (323) Katherine.a.piscopo@kp.org Odaro O. Owen Liver Coordinator Tel: (323) Pgr: (800) odaro.o.owen@kp.org Sharon A. Desposito, RN BMT Coordinator Tel: (626) ext /65285 Pgr: (626) Fax: (626) sharon.a.desposito@kp.org Lesley Anne Erickson, RN BMT Coordinator (H-Q) Tel: (323) Pgr: (323) Fax: (323) lesley.a.erickson@kp.org Mary Margaret Hurst, RN BMT Coordinator (R - Z, All Peds Patients) Tel: (323) Pgr: (323) Fax: (323) mary.m.hurst@kp.org Erwin Macatula, RN BMT Coordinator (A-G) Tel: (323) Pgr: (323) Fax: (323) Erwin.u.macatula@kp.org Clinical Transplant Associates Veronica Banuelos Heart and Lung Transplant Tel: (323) Fax: (323) veronica.s.banuelos@kp.org Lisa U. Do Tel: (323) lisa.u.do@kp.org Deborah E. Green Tel: (323) Fax: (323) deborah.e.green@kp.org Rosita Salvador Tel: (323) rosita.x.salvador@kp.org Healthcare Data Analyst Marmi Maramot Tel: (323) Pgr: (323) Fax: (323) marmi.a.maramot@kp.org Administrative Assistant To be determined Tel: (323) Pgr: (323) Fax: (323)
8 2.5 National Provider Contracting and Network Management Contract Manager Carl Halpern 300 Lakeside Drive, 13 th Floor Tel: (510) Fax:(510) Contract Associate/Provider Relations Consultant Sandra Wellington 300 Lakeside Drive, 13 th Floor Tel: (510) Fax:(510)
9 2.6 Self-Funded Customer Service IVR System Self-Funded Customer Service interactive voice response system (IVR) can assist you with a variety of questions. Call to use this service. Please have the following information available when you call into the system to provide authentication: Provider Tax ID or National Provider Index (NPI) Self-Funded Member s medical record number (MRN) or Self-Funded Member s health record number (HRN) Self-Funded Member s date of birth For Claims Providers will also need to know the date of service The IVR can assist you to verify eligibility, benefits, authorizations and referrals; check a Self-Funded Member s accumulator (amount applied to deductible); inquire about claims and payments; or speak to a customer service representative. Follow the prompts to access these services. 2.7 Website Harrington Health, the Third Party Administrator, will maintain a web site that allows you and your staff to check eligibility, benefit, and claims information for Self-Funded Members. Benefit and eligibility information for self-funded members can be accessed online from either the Harrington Health website ( ) You will then be directed to a log on page. New users to the Harrington Health Web site will be required to self-register to obtain a user ID and password. 9
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