A publication for contracted community physicians

NetworkNEWS

Fall 2018

providers.kp.org/ga

Kaiser Permanente MovesHospital Services to EmoryUniversity Hospital Midtown andEmory Saint Joseph’s HospitalEmory Healthcare, the clinical arm of Emory University, and Kaiser Permanente are collaborating to develop a new care model that provides Kaiser Permanente members with a fully integrated health care experience, and in the process advances patient- and family-centered care in metro Atlanta and beyond. Effective October 23, Emory University Hospital Midtown and Emory Saint Joseph’s Hospital are the primary hospitals for Kaiser Permanentephysicians and members.

• The collaboration includes development ofinfrastructure and joint capacity planning, andthe implementation of collaborative processes on physician staffing, enhanced technology, care coordination, active engagement of patients and families, and ongoing evaluation of performance measures.

• The Southeast Permanente Medical Group(TSPMG) physicians, who care for KaiserPermanente members, will treat our patients atEmory University Hospital Midtown and Emory Saint Joseph’s Hospital. These physicians will oversee our members’ care experience with active engagement of Kaiser Permanente’s care managers and with support from Emory providers.

• Kaiser Permanente maintains some existing serviceaffiliations, including labor and delivery services,which will continue to be provided at Northside Hospital.

• Emory Healthcare continues its existingrelationships with all of its affiliated health plansand continues to serve its members and all existing patients without a change in service or access.

“This unique collaboration combines the highly complementary strengths of Kaiser Permanente and Emory Healthcare, both of which have rich historiesin medical excellence, exceptional service, researchand quality,” said Jim Simpson, president of Kaiser Permanente Georgia. “Our joint focus is to create a premier, integrated care and coverage model committed to improving health and affordability for our members, and better addressing healthdisparities, while working collaboratively to increasethe number of people and communities whobenefit from what our organizations can accomplish together.”

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Need Online Affi liate Link Access?

If you previously had access to Online Affiliate Link, but have lost your access, call the Service Desk is 877-240-1433 and select Option 4 for assistance.

Credentialing NewsKaiser Permanente uses the CAQH Proview®system for the credentialing and re-credentialing of providers. It is important to keep your application accurate and current so that we can credential or re- credential you without requiring additional outreach to you.

After completing your CAQH Proview application, CAQH will notify you every four months to re-attest that all information is still correct and complete. This enables a provider’s contracted participating organizations to access CAQH Proview Profile information based on different re-credentialing cycles. It is very important that you re-attest your application when requested.

From time to time you may be contacted by a staff member of our Credentialing Department for additional information. Please respond with the information requested as quickly as possible to avoid any credentialing or re-credentialing delays.

Have You Moved or Added a Provider?Are you changing locations? Did you acquire another group? Has your phone number changed? Are you no longer accepting new patients? If you answered “yes” to any of these questions, did you let our Provider Contracting Department know of these changes?

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To register for access to Online Affiliate Link, goto www.providers.kp.org/ga. Click on Forms, and it is the first link under “For Providers.” Fill that out and email it to NPSA-PDC-GA@kp.org. Since PHI is involved, the provisioning process can take at least a month, so please be patient.

In an effort for Kaiser Permanente to comply with The Centers for Medicare and Medicaid Services (CMS) requirement of accurate demographic reporting, we need your assistance in keeping provider directory information as current and accurate as possible.

Our online provider directory is only as good asthe demographic updates you provide. We want to ensure that our members have the most up-to-date, accurate, and reliable directory, so they can get the most out of their health plan. We rely on you to help make this happen.

The following information must remain up-to-date:

• Provider name

• Practice name

• Primary and alternate office locations (includingphone number and suite number)

• Are you accepting new patients?

• Change in specialty (example: are you now a PCP, cardiologist, oncologist, orophthalmologist)?

• Notice of provider additions or if provider is nolonger with the practice

If your demographics are changing, or have changed, please let Provider Contracting Department knowat least 60 days in advance, or as soon as possible.Please contact us at ga.provider-relations@kp.org with any changes.

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Web-Based Guest Claims Status CheckContracted and non-contracted providers can view claims’ status as a guest user without registering for Online Affiliate Link under the claims page on the Provider Portal website. Visit www.providers.kp.org/ga.

OLA requires the user to search for a claim by entering a combination of the following c

• Provider NPI or Tax ID

• Billed Amount and Earliest Date of Se

• Member MRN and Date of Birth or LaPatient’s SSN, Date of Birth, and Zip C

New Medicare Senior Advantage Member ID Cards

You will be able to view the followinginformation for a claim:

• Claim Number

• Claim Status

• Claim Type

• Date of Service

• Claim Received Date

• Provider Name

• Vendor Name

• Check Number

• Check Amount

If you require additional claim statusinformation, please login to your existingOnline Affiliate Link account and/or registerfor access by emailing the form found on theProvider Portal forms page.

NEW PROVIDER CONTRACTING FAX:855-324-5362

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Provider Manual UpdatesPlease refer to the following sections of the manual for new updates for 2019. The Provider Manual will be made available in late 2018 in Online Affiliate Link at www.providers.kp.org/ga.

Section 1 & 2• Section 1.4.3 Services Modified at KP Medical

Offices• Section 1.4.8 MRI Added at Stonecrest• Section 1.4.10 After-hours urgent behavioral

health advice nurse• Section 2.1 Medical Records Hours are

8 am - 4:30 pm and QRM can provide a copyof medical criteria used for review

Section 3• Section 3.6.3.1 New Senior Advantage Cards

added• Section 3.10.5 Criteria Restricted Prior

Authorization Medications List changed to becurrent as of 6/20/2018

Section 4• Section 4.2 Concurrent Review requested

information should be sent as soon as possible• Section 4.12 Case Management updated for

transgender and social care needs

Section 5• Section 5.41 added TC for Technical

Component Modifier• Section 5.43-5.44 ClaimsXten does not modify

codes, only modifiers.• Section 5.46 No replacement for duplicate

procedures.

Section 6-8• No changes

Section 9• Training PowerPoint no longer required

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Kaiser Permanente Launches New“Dual Choice” Product SuiteKaiser Permanente is now offering a new Dual Choice PPO plan alongside our traditional HMO plans, providing choice and options for employers whose employees want to maintain relationships with their existing doctors, or who might live outside our 32-county service area. Employers can offer the Complete Suite for their employees with the first effective date on January 1, 2019.

The new Dual Choice product encourages PPO enrollees to experience Permanente medicine through easy access, good service, and financial incentives (e.g., office visit co-pays). If a Dual Choice member receives primary or specialty care from a Kaiser Permanente provider in our medical facilities, they will have a lowerout-of-pocket cost. Members will be able to use any other licensedprovider – but with a higher out-of-pocket cost and leaner benefit plan. While other health plans have similar PPO networks, Kaiser Permanente will offer the only PPO product with access to both Kaiser Permanente medicine and network providers.

Although the region has offered Multi-Choice plans for several years, a major difference in the Dual Choice plans is the significant investments made to improve the member experience, so they can easily access care and understand their benefits. This includes new ID cards with streamlined information, an improved online experience, and direct access to a highly-skilled customer service team. Members from existing Multi-Choice plans will migrate into the new Dual Choice PPO over the next two years.

Key ContactsService Phone

Benefits & Eligibility 404-261-2590 or 888-865

Claims Questions 404-261-2825 or 800-221

Emergency Care Management Hub 404-365-4254

Exchange Member Services 770-291-6897

Online Affiliate Help 877-240-1433 (option 4)

Provider Contracting 404-364-4934

Referrals & Authorizations 404-364-7320 or 1-800-22

Self-Funded Member Services 1-866-800-1486

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Kaiser Foundation Health plan of Georgia, Inc. Nine Piedmont Center 3495 Piedmont Road N.E. Atlanta, GA 30305-1736

Address Service Requested

Please Recycle. 61183109 10/18

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