Provider Manual. Billing and Payment

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1 Provider Manual Billing and Payment

2 Billing and Payment This section of the Manual was created to help guide you and your staff in working with Kaiser Permanente s billing and payment policies and procedures. It provides a quick and easy resource with contact phone numbers, detailed processes and site lists for services. If, at any time, you have a question or concern about the information in this Manual, you can reach our Provider Inquiry Department by calling or

3 Table of Contents INTRODUCTION... 6 SECTION 5: BILLING AND PAYMENT WHOM TO CONTACT WITH QUESTIONS METHODS OF CLAIMS FILING PAPER CLAIM FORMS RECORD AUTHORIZATION NUMBER ONE MEMBER/ PROVIDER PER CLAIM FORM NO FAULT/ WORKERS COMPENSATION/OTHER ACCIDENT ENTERING DATES MULTIPLE DATES OF SERVICES AND PLACE OF SERVICES SURGICAL AND/OR OBSTETRICAL PROCEDURES BILLING INPATIENT CLAIMS THAT SPAN DIFFERENT YEARS SUPPORTING DOCUMENTATION FOR PAPER CLAIMS (REQUIRED) WHERE TO MAIL/FAX PAPER CLAIMS ELECTRONIC DATA INTERCHANGE (EDI) ELECTRONIC CLAIMS FORMS SUPPORTING DOCUMENTATION FOR EDI CLAIMS (REQUIRED) TO INITIATE ELECTRONIC CLAIMS SUBMISSIONS ELECTRONIC SUBMISSION PROCESS KP Contracted Clearinghouses HIPAA REQUIREMENTS CLEAN CLAIMS

4 5.21 CLAIMS SUBMISSION TIMEFRAMES (REQUIRED) CLAIMS PROCESSING TURN AROUND TIME (REQUIRED) Appeal of Timely Claims Submission 5.24 PROOF OF TIMELY CLAIMS SUBMISSION (REQUIRED) Claim Adjustments/Corrections Incorrect Claims Payments (Required) REJECTED CLAIMS DUE TO EDI CLAIMS ERROR (REQUIRED) FEDERAL TAX ID NUMBER (REQUIRED) CHANGES IN FEDERAL TAX ID NUMBER (REQUIRED) NATIONAL PROVIDER IDENTIFICATION (NPI) (REQUIRED) Member Cost Share Member Claims Inquiries Visiting Members (Required) Coding for Claims (Required) Coding Standards Modifiers in CPT and HCPCS (Required) Modifier Review CODING & BILLING VALIDATION (REQUIRED) Coding Edit Rules (Required) Medical Claims Review (Required)...30 Major Categories of Claim Coding Errors/Inconsistencies...30 Incidental Procedures...31 Mutually Exclusive Procedures...31 Age and Gender (Sex) Conflicts...32 Obsolete/Deleted Codes...32 Multiple/ Duplicate Component Billing

5 5.41 Other Party Liability (OPL) Workers Compensation PROVIDER CLAIMS APPEALS (REQUIRED) CMS 1500 (08/05) FIELD DESCRIPTIONS CMS 1450 (UB 04) FIELD DESCRIPTIONS BILLING REQUIREMENTS AND INSTRUCTION FOR SPECIFIC SERVICES Evaluation Management (E/M) Services Emergency Rooms Durable Medical Equipment Injection/ Immunizations Newborn Services Expanded Care 5.47 Anesthesia COORDINATION OF BENEFITS (COB) How to Determine the Primary Payor Description of COB Payment Methodologies COB Claims Submission Requirements and Procedures Members Enrolled in Two Kaiser Permanente Plans COB Claims Submission Timeframes COB FIELDS ON THE UB 92 and UB 04 CLAIM FORM COB FIELDS ON THE CMS 1500 (HCFA 1500) CLAIM FORM EXPLANATION OF PAYMENT (EOP) (REQUIRED)

6 Introduction At the heart of Kaiser Permanente s claim processing operation is the set of policies and procedures followed in determining the appropriate handling and reimbursement of claims received. Kaiser Permanente uses code editing software from third party vendors to assist in determining the appropriate handling and reimbursement of claims. Currently, Kaiser Permanente has selected IntelliClaim, which in turn uses software from McKesson and Claims Edit System (CES) Knowledgebase. From time to time, Kaiser Permanente may change this coding editor or the specific rules that it uses in analyzing claims submissions. Kaiser Permanente s goal is to help ensure the accuracy of claims payments. IntelliClaim is a code editor software application designed to evaluate professional claims data including HCPCS and CPT codes as well as associated modifiers. IntelliClaim is a rule-based application; some of these rules have been chosen to meet Kaiser Permanente s goals of increased accuracy in claims payment. IntelliClaim assists Kaiser Permanente in identifying various categories of claims coding and possible inconsistencies. Claims with coding errors/inconsistencies are pended to the Medical Claim Review staff for manual review. Each claim is validated against Kaiser Permanente s payment criteria, and then is subsequently released for processing. This process has a goal of improving the accuracy of coding and consistency in claims payment procedures. In order to help illustrate how this process works, examples have been provided where appropriate. If you have questions about the application of these rules, please contact our Claims Inquiry Unit. It is your responsibility to submit itemized claims for services provided to Members in a complete and timely manner in accordance with your Agreement, this Manual and applicable law. The Member s Payor is responsible for payment of claims in accordance with your Agreement 5.1 Whom to Contact with Questions If you have any questions relating to the submission of claims to Kaiser Permanente for processing, please refer to the table below for the correct department/number to call: PLEASE CALL: IF YOU HAVE QUESTIONS ABOUT: TELEPHONE NUMBER(S): CLAIMS ADMINISTRATION Coordination of Benefits (COB Third Party Liability (TPL) COB Local Telephone #: (503) COB Toll-Free Telephone #: (888) TPL Local Telephone #: (503) TPL Toll-Free Telephone #: (866)

7 PLEASE CALL: IF YOU HAVE QUESTIONS ABOUT: TELEPHONE NUMBER(S): Fax #: (503) Address: Kaiser Permanente Claims Administration Department 500 NE Multnomah Street, Suite 100 Portland, OR CLAIMS INQUIRY Benefits/Co-Pay Information Claim Payment Inquiries * Claim Status * Claim Submission Explanation of Payment (EOP) Medical Policy Questions Member Eligibility Referral Questions Local Telephone #: (503) Toll-Free Telephone #: (866) Address: Kaiser Permanente Claims Inquiry Unit 500 NE Multnomah Street, Suite 100 Portland, OR For Questions regarding Refunds and Refund Requests Local Telephone #: (503) Toll-Free Telephone #: (800) Address: Kaiser Permanente Claims Inquiry Unit 500 NE Multnomah Street, Suite 100 Portland, OR PROVIDER CONTRACTING & RELATIONS Contracts Credentialing Fee Schedule Participation Request Participation Status Practice Demographic Updates Provider Appeals Referral Policy Orientation Local Telephone #: (503) Fax #: (503) Address: Kaiser Permanente Provider Contracting & Relations 500 NE Multnomah Street, Suite 100 Portland, OR

8 5.2 Methods of Claims Filing Kaiser Permanente of the Northwest accepts all claims submitted by mail or electronically. 5.3 Paper Claim Forms CMS-1500 (8/05) must be used for all professional services and suppliers. UB-04 (CMS-1450) must be used by all facilities (e.g., hospitals). Any professional services (for example, services rendered by radiologists, ER physicians, etc.) should be billed on CMS-1500 claim forms, unless you are contracted under a GLOBAL rate, in which case professional services should not be billed separately. Please use standard claim forms formatted with RED ink to ensure maximum compatibility with Kaiser Permanente s optical scanning equipment. Claim forms formatted with black or blue lines will not scan as efficiently as those formatted with RED. 5.4 Record Authorization Number 5.5 One Member/ Provider per Claim Form 5.6 No Fault/ Workers Compensation/ Other Accident 5.7 Entering Dates Services that require prior authorization must have an authorization number reflected on the claim form. CMS 1500(8/05) Form If applicable, enter the Authorization Number (Field 23) and the Name of the Referring Provider (Field 17) on the claim form, to ensure efficient claims processing and handling. One Member per Claim Form/One Provider per claim Do not bill for different Members on the same claim form Do not bill for different Providers on the same claim form. Separate claim forms must be completed for each Member and for each Provider Be sure to indicate on the CMS-1500 (HCFA-1500) Claim Form in the Is Patient s Condition Related To fields (Fields 10a -10c), whenever No Fault, Workers Compensation, or Other Accident situations apply. All dates (dates of birth, dates of service, etc.) must be reported in the following format: month, day, and FOUR DIGITS for the year (MM/DD/YYYY)

9 Example: 01/05/2008 CONSECUTIVE DATES OF SERVICE Consecutive dates of service can be billed on one claim line as long as the units entered in Field 24g equal the total number of days billed. Example: Correct Way to Bill CPT/HCPCS DATE OF SERVICE UNITS /05/ /07/ /09/ /13/ Incorrect Way to Bill CPT/HCPCS DATE OF SERVICE UNITS /05/ /13/

10 5.8 Multiple Dates of Services and Place of Services DIFFERENT PLACES OF SERVICE When services are rendered in DIFFERENT places of service (locations), a separate claim form must be submitted for EACH different place of service. SAME PLACES OF SERVICE Whenever services are provided in the SAME place of service, on DIFFERENT dates, these services may be reported and listed as separate lines on ONE claim form, along with the corresponding date, diagnosis code(s), procedure code(s), and charges. 5.9 Surgical and/or Obstetrical procedures 5.10 Billing Inpatient Claims That Span Different Years 5.11 Supporting Documentation for Paper Claims If any surgical and/or obstetrical procedures were performed, record the ICD-9-CM principal procedure and date in Field 80 (Principal Procedure Code and Date) and enter any additional ICD-9-CM procedure codes and corresponding dates in Field 81A-E (Other Procedure Codes and Dates). When submitting the UB-04, use Field 74a-e (Principal Procedure Code and Date) When an inpatient claim spans different years (for example, the patient was admitted in December and was discharged in January of the following year), it is NOT necessary to submit two claims for these services. Bill all services for this inpatient stay on one claim form (if possible), reflecting the correct date of admission and the correct date of discharge. Kaiser Permanente will apply the appropriate/applicable payment methodologies when processing these claims. To expedite claims processing and adjudication, a Practitioner/Provider should submit supporting written documentation (for example, copies of pertinent medical records) with certain types of claims. Supporting Documentation Submitted WITH a Claim: When supporting documentation is submitted WITH the corresponding paper claim form, attach/secure the documentation to the paper claim with a paper clip (do not staple) and mail to Kaiser Permanente s mailing address. Supporting Documentation Submitted SEPARATELY From a Claim: When sending supporting documentation SEPARATELY from the claim (for example, when sending in requested medical information for a pended claim)

11 5.12 Where to Mail Paper Claims Kaiser Permanente Claims Administration 500 NE Multnomah Street, Suite 100 Portland, OR Note: Faxed Claims are not acceptable 5.13 Electronic Data Interchange (EDI) Electronic Claim Submissions: Kaiser Permanente encourages electronic submission of claims. EDI is an electronic exchange of information in a standardized format that adheres to all Health Insurance Portability and Accountability Act (HIPAA) requirements. EDI transactions replace the submission of paper claims. Required data elements (for example, claims data elements) are entered into the computer only ONCE - typically at the Provider s office, or at another location where services were rendered. Benefits of EDI Submission 1 Reduced Overhead Expenses: Administrative overhead expenses are reduced, because the need for handling paper claims is eliminated. 2 Improved Data Accuracy: Because the claims data submitted by the Provider is sent electronically to Kaiser Permanente via the Clearinghouse, data accuracy is improved, as there is no need for re-keying or re-entry of data. 3 Low Error Rate: Additionally, up-front edits applied to the claims data while information is being entered at the Provider s office, and additional payer-specific edits applied to the data by the Clearinghouse before the data is transmitted to the appropriate payer for processing, increase the percentage of clean claim submissions. 4 Bypass US Mail Delivery: The usage of envelopes and stamps is eliminated. Providers save time by bypassing the U.S. mail delivery system. 5 Standardized Transaction Formats: Industry-accepted standardized medical claim formats may reduce the number of exceptions currently required by multiple payers. NOTICE TO ALL PROVIDERS: Even though you may be reimbursed under a capitated arrangement, periodic interim payments (PIP), or other reimbursement methodology, you are still required to submit Member Encounter Data to Kaiser Permanente electronically (preferred) or via standard claim forms (CMS-1500/08/05 or UB-04), and to follow all claims completion instructions set forth in this Manual

12 5.14 Electronic Claims Forms 5.15 Supporting Documentation for EDI Claims Currently, Kaiser Permanente receives and sends the following electronically via the current 4010A1 version through our contracted Clearinghouses 837P must be used for all professional services and suppliers. 837I must be used by all facilities (e.g., hospitals).below To expedite claims processing and adjudication, a Practitioner/Provider should submit supporting written documentation (for example, copies of pertinent medical records) with certain types of claims. Supporting Documentation Submitted SEPARATELY From a Claim: When sending supporting documentation SEPARATELY from the claim (for example, when sending in requested medical information for a pended claim) 1) Complete a Supporting Documentation Cover Sheet for each Member for whom you are submitting paper documentation. 2) Attach the cover sheet to each Member s paper documentation with a paper clip. 3) Mail the supporting documentation as per the instructions on the form To Initiate Electronic Claims Submissions A Practitioner/Provider may be contacted by Kaiser Permanente and encouraged to submit claims electronically. 1) Written Request/Call Alternately, a Practitioner/Provider may initiate the call (or may submit a written request) to our Provider Contracting & Relations Department, asking that they be set up to transmit claims electronically to Kaiser Permanente. This information will be relayed to the Regional EDI Coordinator. 2) Verifying Connection Is Established Upon receipt of the EDI request from the Practitioner/Provider, the Regional EDI Coordinator from Kaiser Permanente will contact the Practitioner/Provider to confirm that they have established a connection with a Clearinghouse that Kaiser Permanente contracts

13 with. If not, Kaiser Permanente will assist in informing the Practitioner/Provider in the steps to take. 3) EDI Set-Up Once the Practitioner s/provider s billing information and verification processes are complete, a representative from either the selected Clearinghouse and/or Kaiser Permanente s Regional EDI Coordinator will contact the Practitioner/Provider to work through the technical components of electronic claim testing and submissions

14 5.17 Electronic Submission Process 1) Practitioners /Providers EDI Responsibilities: Once a Practitioner/Provider has entered all of the required data elements (i.e., all of the required data for a particular claim) into a computer system, the Practitioner/Provider then electronically sends all of this information to a Clearinghouse for further data sorting and distribution. 2) Clearinghouse s EDI Responsibilities: The Clearinghouse receives information electronically from a variety of Practitioners and Providers, who have chosen that particular Clearinghouse as their data sorter and distributor. The Clearinghouse batches all of the information it has received from the various Practitioners and Providers, sorts the information, and then electronically sends the information to the correct payer for processing. Data content required by HIPAA Transaction Implementation Guides is the responsibility of the Practitioner/Provider and the Clearinghouse. The Clearinghouse should ensure HIPAA Transaction Set Format compliance with HIPAA rules. In addition, Clearinghouses: Frequently supply the required PC software to enable direct data entry in the Practitioner s/provider s office. Edit the data which is electronically submitted to the Clearinghouse by the Practitioner s/provider s office, so that the data submission will be accepted by the appropriate payer for processing. Transmit the data to the correct payer in a format easily understood by the payer s computer system. Transmit electronic claim status reports from payers to Practitioners/Providers. 3) Kaiser Permanente s EDI Responsibilities: Kaiser Permanente receives EDI information after the Practitioner/Provider sends it to the Clearinghouse for distribution. The data is loaded into Kaiser Permanente s computer electronically and is prepared for further processing

15 On the same business day that Kaiser Permanente receives the EDI claims, Kaiser Permanente EDI Transaction Solution (KPEDITS) prepares a 997 electronic acknowledgement which is transmitted back to the Clearinghouse. NOTE: If you do not receive Kaiser Permanente s 997 electronic claim acknowledgements from the Clearinghouse, contact your billing service or the Clearinghouse and request that this be routinely forwarded to you. Additionally, Kaiser Permanente provides a Kaiser Permanente EDI Transaction Solutions (KP EDITS) Reject Detail Report for those claims which were rejected by KP EDITS because of fatal front-end errors. Any rejected claims may be re-submitted electronically once the claims have been corrected by the Practitioner/Provider. NOTE: See the Claims Status Category and Reason Codes at for a list of common Insurance Business Process Application error codes that prevent a claim from being accepted by Kaiser Permanente

16 5.18 KP Contracted Clearinghouses Clearinghouse Payer IDs as of 11/07/2006 Clearing House Payer IDs as of 11/07/2006 Cortex EDI Emdeon (WebMD, Envoy) Gateway EDI KS007 (837P) MedAvant (ProxyMed) KS007 (837P) or (837I) Medisoft KS007 (837P) NDCHealth (837P) or (837I) Office Ally Payer Connection KS007 (837P) Per Se (837P) RelayHealth RH002 (837I and 837P) THIN (Thinedi) KS007 (837P) or (837I) Zirmed Z1059 Providers should access their Clearinghouses to identify the Payer Id for Kaiser Foundation NW HIPAA Requirements PLEASE NOTE: Payer IDs are for both 837I (UB) and 837P (HCFA) transactions unless otherwise noted. Also, these Payer IDs are only for Kaiser Foundation Health Plan of the Northwest. If you wish to submit EDI claims to another Kaiser Permanente region, you must obtain the appropriate Payer ID from your Clearinghouse or the appropriate region. All electronic claim submissions must adhere to all HIPAA requirements. The following websites (listed in alphabetical order) include additional information on HIPAA and electronic loops and segments. If a Provider does not have internet access, HIPAA Implementation Guides can be ordered by calling Washington Publishing Company (WPC) at (301) Clean Claims Kaiser Permanente considers a claim clean when the following requirements are met. Correct Form - Kaiser Permanente requires all professional claims to be submitted using the CMS Form 1500(8/05) and all facility claims (or appropriate ancillary services) to be submitted using the CMS Form CMS 1450 (UB04). Standard Coding All fields should be completed using industry standard coding. Applicable Attachments Attachments should be included in your submission when circumstances require additional information

17 Completed Field Elements for CMS Form 1500 (08/05 ) Or CMS 1450 (UB- 04) All applicable data elements of CMS forms should be completed. A claim is not considered to be Clean or payable if one or more of the following are missing or are in dispute: The standards or format used in the completion or submission of the claim The eligibility of a person for coverage The responsibility of another payor for all or part of the claim The amount of the claim or the amount currently due under the claim The benefits covered The manner in which services were accessed or provided The claim was submitted fraudulently 5.21 Claims Submission Timeframes 5.22 Claims Processing Turn-Around Time Note: Failure to include all information will result in a delay in claim processing and payment and it will be returned for any missing information. A claim missing any of the required information will not be considered a clean claim. New Claims: 365 Days from Date of Service(DOS) COB Claims: 365 Days from date of Primary EOP Self Funded Claims: 120 Days from DOS Clean Claims: Please allow 30 days for Kaiser Permanente to process and adjudicate your claim(s). Claims requiring additional supporting documentation and/or coordination of benefits may take longer to process. NOTE: While Kaiser Permanente may require the submission of specific supporting documentation necessary for benefit determination (including medical and/or coordination of benefits information), Kaiser Permanente may have to make a decision on the claim before such information is received. A "complete or clean" claim is defined as a claim that has no defect or impropriety, including lack of required substantiating documentation from providers, suppliers, or Members or particular circumstances requiring special treatment that prevents timely payments from being made on the claim Appeal of Timely Claims Submission Resubmitted claims along with proof of initial timely filing received within 365 days of the original date of denial or explanation of payment, will be allowed for reconsideration of claim processing and payment. Any claim

18 resubmissions received for timely filing reconsideration beyond 365 days of the original date of denial or explanation of payment will be denied as untimely submitted Proof of Timely Claims Submission Claims submitted for consideration or reconsideration of timely filing must be reviewed with information that indicates the claim was initially submitted within the appropriate time frames. Acceptable proof of timely filing may include the following documentation and/or situations: Proof or Documentation Examples System generated claim copies, account print-outs, or reports that indicate the original date that claim was submitted, and to which insurance carrier. *Hand-written or typed documentation is not acceptable proof of timely filing. Account ledger posting that includes multiple patient submissions Individual Patient ledger CMS UB04 or 1500(8/05) with a system generated date or submission. EDI Transmission report Reports from a Provider Clearinghouse (i.e. WebMD) Lack of member insurance information. Proof of follow-up with member for lack of insurance or incorrect insurance information. *Members are responsible for providing current and appropriate insurance information each time services are rendered by a provider. Copies of dated letters requesting information, or requesting correct information from the member. Original hospital admission sheet or face sheet with incomplete, absent, or incorrect insurance information. Any type of demographic sheet collected by the provider from the member with incomplete, absent, or incorrect insurance information Claim Adjustments/ Corrections CMS-1500 (08/05) Claim Forms: NOTE: Kaiser Permanente prefers corrections to 837P claims which were already accepted by Kaiser Permanente to be submitted on paper claim forms. Corrections submitted electronically may inadvertently be denied as a duplicate claim. Refer to page Error! Bookmark not defined. within this GUIDE for further information/instructions. When submitting a corrected CMS-1500 (08/05) paper claim to Kaiser Permanente for processing:

19 1) Write CORRECTED CLAIM in the top (blank) portion of the standard claim form. 2) Attach a copy of the corresponding page of Kaiser Permanente s Explanation of Payment (EOP) to each corrected claim, to prevent these claims from being rejected by Kaiser Permanente as duplicate claims. Attach with a paper clip. 3) Mail the corrected claim(s) to Kaiser Permanente using the standard claims mailing address (see page Error! Bookmark not defined. in this section). UB-04 Claim Forms (837I): NOTE: 837I corrections may be submitted electronically. When submitting a corrected UB-04 claim to Kaiser Permanente for processing: Electronic Include the appropriate Type of Bill code when electronically submitting a corrected UB-04/837I claim to Kaiser Permanente for processing. Paper When submitting a corrected or UB-04 paper claim to Kaiser Permanente for processing: 1) Include the appropriate Type of Bill code in Field 4. 2) Attach a copy of the corresponding page of Kaiser Permanente s Explanation of Payment (EOP) to each corrected claim, to prevent these claims from being rejected by Kaiser Permanente as duplicate claims. Attach with a paper clip. 3) Mail the corrected claim(s) to Kaiser Permanente using the standard claims mailing address (see page Error! Bookmark not defined. in this section)

20 5.26 Incorrect Claims Payments If you receive an incorrect payment (i.e., either an overpayment or an underpayment), please do one of the following: Option 1: Do not cash or deposit the incorrect payment check. Mail the incorrect payment check back to Kaiser Permanente, along with a copy of the Explanation of Payment (EOP) and a brief note explaining the payment error to: Kaiser Permanente Claims Administration 500 Multnomah St, Suite 100 Portland, OR NOTE: If Kaiser Permanente s EOP is not available, please record the Member s Health Record Number and/or Claim Number on the payment check you are returning. Kaiser Permanente will re-issue and mail you a new, corrected payment check within 30 days. Option 2: Deposit the incorrect Kaiser Permanente payment check in your account. For an Underpayment Error: Write or call our Claims Inquiry Unit and explain the error. Upon verification of the error, appropriate corrections will be made to Kaiser Permanente s accounting system and the underpayment amount owed will be reflected in a Kaiser Permanente reimbursement check within 30 days. For an Overpayment Error: Please do the following: 1) Write a refund check to Kaiser Permanente for the excess amount paid to you by Kaiser Permanente. Attach a copy of Kaiser Permanente s Explanation of Payment to your refund check, as well as a brief note explaining the error. Attach with a paper clip. NOTE: If Kaiser Permanente s EOP is not available, please record the Member s Health Record Number on the payment check you are returning

21 2) Mail your refund check (and brief note) to: Kaiser Permanente Claims Administration, Recoveries Unit 500 NE Multnomah St, Suite 100 Portland, OR

22 5.27 Rejected Claims Due to EDI Claims Error Electronic Claim Acknowledgement: Kaiser Permanente sends an electronic claim acknowledgement to the Clearinghouse. This claims acknowledgement will be forwarded to you as confirmation of all claims received by Kaiser Permanente. NOTE: If you are not receiving Kaiser Permanente s electronic claim receipt from the Clearinghouse, contact the Clearinghouse and request that this be routinely forwarded to you Federal Tax ID Number The Federal Tax ID Number as reported on any and all claim form(s) must match the information filed with the Internal Revenue Service (IRS). 1 When completing IRS Form W-9, please note the following: Name: This should be the equivalent of your entity name, which you use to file your tax forms with the IRS. Sole Provider/Proprietor: List your name, as registered with the IRS. Group Practice/Facility: List your group or facility name, as registered with the IRS. 2 Business Name: Leave this field blank, unless you have registered with the IRS as a Doing Business As (DBA) entity. If you are doing business under a different name, enter that name on the IRS Form W-9. 3 Address/City, State, Zip Code: Enter the address where Kaiser Permanente should mail your IRS Form Taxpayer Identification Number (TIN): The number reported in this field (either the social security number or the employer identification number) MUST be used on all claims submitted to Kaiser Permanente. Sole Provider/Proprietor: Enter your taxpayer identification number, which will usually be your social security number (SSN), unless you have been assigned a unique employer identification number (because you are doing business as an entity under a different name). Group Practice/Facility: Enter your taxpayer identification number, which will usually be your unique employer identification number (EIN). If you have any questions regarding the proper completion of IRS Form W

23 9, or the correct reporting of your Federal Taxpayer ID Number on your claim forms, please contact the IRS help line in your area or refer to the following website: Completed IRS Form W-9 should be mailed to the following address: Kaiser Permanente <Provider Contracting and Relations 500 NE Multnomah Ste 100 Portland, OR 97232> 5.29 Changes in Federal Tax ID Number If your Federal Tax ID Number should change, please notify us immediately, so that appropriate corrections can be made to Kaiser Permanente s files National Provider Identification (NPI) The Health Insurance Portability and Accountability Act of 1996 (HIPPA) mandates that all providers use a standard unique identifier on all electronic transactions. Your National Provider Identifier (NPI) must be used on all HIPPA-standard electronic transactions by May 23, For additional information regarding the National Provider Identifier (NPI), how to apply and report please contact the Center for Medicare & Medicaid Services (CMS) or refer to the following website: Member Cost Share Depending on the benefit plan, Kaiser Permanente Members may be responsible to share some cost of the services provided. Copayment, coinsurance and deductible (collectively, Member Cost Share ) are the fees a Member is responsible to pay a Provider for certain covered services. This information varies by plan and all Providers are responsible for collecting Member Cost Share in accordance with Kaiser Permanente Member s benefits unless explicitly stated otherwise in your Agreement. Please verify applicable Member Cost Share at the time of service. Member Cost Share information can be obtained from: Member Services at or

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