A Guide to Provider Credentialing with Kaiser Permanente

Kaiser Permanente consists of:

• Kaiser Foundation Health Plans (the insurance component)
• Kaiser Foundation Hospitals
• Permanente Medical Groups (physician-led organizations that provide care to Kaiser members)
  

Kaiser Permanente offers several types of provider relationships:

1. Employed Physicians and Providers: Practitioners who work directly for one of the Permanente Medical Groups.
2. Contracted Providers: Independent practitioners or groups who provide services to Kaiser members through formal contracts.
3. Affiliated Providers: Providers who have privileges at Kaiser facilities but are not directly employed.
4. Community Providers: Independent practitioners who provide services to Kaiser members on a referral basis when services are not available within Kaiser’s network.
   

The credentialing process typically involves the following steps:

1. Initial Application

The credentialing process begins with an initial application. Providers must submit comprehensive information about their education, training, work history, and current practice. Unlike some other insurers, Kaiser Permanente’s application process may begin with an invitation to apply rather than an open application, particularly for employed positions.

2. Primary Source Verification

Kaiser Permanente conducts thorough primary source verification of all credentials, including:

• Medical education and training
• Board certifications
• State medical licenses
• DEA registration
• Work history
• Malpractice history
• National Practitioner Data Bank reports
• Office of Inspector General (OIG) exclusion list screening

3. Peer Review and Evaluation

Kaiser Permanente’s credentialing committee, composed of peer physicians, reviews the application and verification results. This committee evaluates the provider’s qualifications, practice patterns, and professional conduct.

4. Site Visit and Assessment

For certain provider types, particularly those who will be seeing patients in non-Kaiser facilities, a site visit may be conducted to assess the practice location, medical record keeping, accessibility, and adherence to safety standards.

5. Final Determination

Based on the comprehensive review, Kaiser Permanente’s credentialing committee makes a final determination on the provider’s application. This decision may include full approval, conditional approval, or denial.

6. Recredentialing

Kaiser Permanente requires recredentialing every three years. This process verifies that providers continue to meet the organization’s standards and have maintained their credentials.

Education and Training Requirements

Kaiser Permanente requires providers to have:

• Graduation from an accredited medical school or appropriate professional school
• Completion of a residency program in the specialty in which the provider will practice
• Current board certification or active pursuit of board certification (typically within 5 years of completing training)

Licensure and Certification Requirements

Providers must maintain:

• Current, unrestricted state medical license in the state where they’ll practice
• Current, unrestricted DEA registration (if applicable)
• Current malpractice insurance meeting Kaiser Permanente’s minimum coverage requirements (typically $1 million per occurrence/$3 million aggregate, though this may vary by specialty and location)
• Appropriate board certification or eligibility

Professional Standards and Conduct Requirements

Kaiser Permanente evaluates providers based on:

• No history of license revocation or suspension
• No history of Medicare/Medicaid exclusion
• No felony convictions related to healthcare
• No pattern of excessive malpractice claims
• Demonstrated adherence to clinical practice guidelines and evidence-based medicine
• Commitment to Kaiser Permanente’s quality standards and patient-centered approach
  

Kaiser Permanente operates across multiple regions, each with its own Permanente Medical Group:

• Northern California (The Permanente Medical Group)
• Southern California (Southern California Permanente Medical Group)
• Northwest (Northwest Permanente)
• Hawaii (Hawaii Permanente Medical Group)
• Colorado (Colorado Permanente Medical Group)
• Mid-Atlantic States (Mid-Atlantic Permanente Medical Group)
• Washington (Washington Permanente Medical Group)
• Georgia (Southeast Permanente Medical Group)
  

Steps for utilizing CAQH with Kaiser Permanente:

1. Register with CAQH ProView if you haven’t already
2. Ensure your CAQH profile is complete and up-to-date
3. Authorize Kaiser Permanente to access your CAQH data
4. Regularly update your CAQH information
   

These portals vary by region but typically include:

• KP Provider Connect
• KP Link
• Regional provider portals for specific Permanente Medical Groups

These portals allow providers to:

• Check credentialing status
• Update practice information
• Access clinical resources
• Submit claims (for contracted providers)
• Communicate with Kaiser Permanente departments
  

However, this timeframe can vary based on:

• Completeness of the initial application
• Complexity of the provider’s history
• Responsiveness to requests for additional information
• Regional variations in processing times
• Employment versus contracting status
  

Before Applying

1. Research Kaiser Permanente’s Needs: Understand the specific needs of the Kaiser Permanente region where you’re applying. Some regions may have greater needs for certain specialties or in specific geographic areas.
2. Understand the Integrated Model: Familiarize yourself with Kaiser Permanente’s integrated care model and how your practice would fit within it.
3. Prepare Your Documentation:
   • Gather all necessary documentation, including:
     • Medical school diploma
     • Residency/fellowship certificates
     • Board certification
     • State medical licenses
     • DEA registration
     • Current CV
     • Malpractice insurance documentation
     • Professional references
4. Update Your CAQH Profile: Ensure your CAQH ProView profile is complete and current.

During the Application Process

1. Be Thorough and Accurate: Complete all application materials thoroughly and accurately. Inconsistencies or omissions can delay the process.
2. Respond Promptly: Address any requests for additional information or clarification promptly.
3. Follow Up Appropriately: Check on your application status periodically, but avoid excessive inquiries.
4. Prepare for the Interview: If applying for an employed position, prepare for a formal interview process that evaluates both clinical skills and cultural fit with Kaiser Permanente’s team-based approach.

After Credentialing Approval

1. Complete Orientation: Kaiser Permanente typically requires new providers to complete orientation to their systems and processes.
2. Learn the EMR System: Kaiser Permanente uses Epic as its electronic medical record system. Familiarity with this system is crucial.
3. Understand Kaiser Permanente’s Clinical Guidelines: Familiarize yourself with Kaiser Permanente’s clinical practice guidelines and quality metrics.
4. Prepare for Ongoing Monitoring: Kaiser Permanente continuously monitors provider performance through various quality metrics and patient satisfaction scores.
   

Primary Care Providers

Primary care providers often have additional requirements, including:

• Demonstrated experience in preventive care
• Comfort with team-based care models
• Ability to coordinate care across specialties
• Familiarity with population health management

Specialists

Specialists should be prepared to:

• Work collaboratively with Kaiser Permanente primary care providers
• Follow Kaiser Permanente’s referral processes
• Adhere to Kaiser Permanente’s practice guidelines for their specialty
• Participate in quality improvement initiatives

Allied Health Professionals

Non-physician providers such as nurse practitioners, physician assistants, and therapists have specific credentialing requirements that may include:

• Appropriate supervision agreements
• Collaborative practice agreements
• Scope of practice documentation
• Additional state-specific requirements
  

If you encounter challenges during the Kaiser Permanente credentialing process, consider these strategies:

1. Address Gaps or Issues Proactively: If you have gaps in your work history, malpractice claims, or other potential red flags, address them proactively in your application with appropriate context and explanation.
2. Provide Additional Documentation: Be prepared to provide additional documentation or references to support your application if requested.
3. Request Reconsideration: If your application is denied, you may have the opportunity to request reconsideration. Provide any new information that might influence the decision.
4. Seek Feedback: If unsuccessful, request specific feedback on areas where you could strengthen your application for future consideration.