Kaiser Permanente is a closed-network system where most claims are handled internally. Out-of-network providers submit claims to the regional Kaiser entity where the member is enrolled. Filing deadlines vary by region: typically 90-180 days from date of service.
Day 1: Identify correct Kaiser regional entity. Days 1-5: Submit electronic claim with required fields. Days 6-30: Kaiser adjudicates clean claims. Days 31-45: Payment processed for approved claims. If claim pends: Kaiser may request additional documentation.
| CARC Code | Reason | Primary Cause | Fix |
|---|---|---|---|
| CO-29 | Timely filing exceeded | Claim filed after regional deadline | Check your Kaiser region's specific deadline |
| CO-15 | Workers comp exclusion | Service is work-related | Verify injury is not work-related before billing Kaiser |
| CO-50 | Non-covered service | Service outside Kaiser benefits | Verify coverage and obtain auth before service |
Appeal denied claims within 180 days of the denial date. Submit to the Kaiser regional appeals department. Include the denial notice, clinical documentation, and a letter explaining why the claim should be paid. Response time: 30 calendar days.
Submit electronic claims through Availity or mail paper claims to the Kaiser regional claims address listed on the member's ID card. Include the member's MRN and the referral or authorization number if applicable.
It varies by region. Northern California: 180 days. Southern California: 90 days for non-emergency. Check with the specific Kaiser regional entity for exact deadlines.
Yes. Emergency services do not require prior authorization under federal law. Submit claims within 90 days of the emergency service date with supporting clinical documentation.
Altair identifies the correct Kaiser region and filing deadline for every member automatically.