2.1 Key Contacts for Self-Funded Member Inquiries. Help or Information Available from this Department Self-Funded Customer Service

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1 2. Key Contacts 2.1 Key Contacts for Self-Funded Member Inquiries Department Contact information Help or Information Available from this Department Self-Funded Customer Service Customer service representatives are available Monday through Friday 7 a.m. to 9 p.m. Eastern Time Zone (Until 6 p.m. Pacific Time Zone) Self-Service IVR System available: 24 hours / 7 days a week (800) Website available: 24 hours / 7 days a week General enrollment questions Eligibility and benefit verification Claims management Billing and payment inquiries Electronic Data Interchange (EDI) questions Member appeals Claims inquiries and disputes Co-pay, deductible and co-insurance information Members presenting without Health ID Card or MRN Verifying Member s PCP assignment 2.2 Self-Funded Customer Service Interactive Voice Response System (IVR) Self-Funded Customer Service IVR can assist you with a variety of questions. Call (800) 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 Identifier (NPI) Member s MRN Member s date of birth Date of service for claim in question The IVR can assist you with verification of eligibility, benefits, authorizations, referrals, status of a Member s accumulator (amount applied toward deductible); claims and payment status; or connect you to a customer service representative. Follow the prompts to access these services. 4

2 2.3 Self-Funded Website Harrington Health, the TPA, maintains a website that allows you and your staff to verify eligibility, benefit, and claims information for Members. The Self-Funded website can be directly accessed at Registration instructions are on the website. NOTE: This website is restricted to information for individuals enrolled in Self-Funded plans administered by Northern California KPIC only. Information regarding Members enrolled in KP s fully funded plans (e.g., HMO), cannot be accessed from the Self-Funded website. 2.4 Northern California Region Key Contacts Department Area of Interest Contact Information Medical Services Contracting Contract Management and Provider Relations Updates to Provider demographics, such as Tax ID and ownership changes, address changes Practitioner additions/terminations to/from your group Provider education and training Contract interpretation Form requests Billing, payment or other dispute issues Facility Credentialing (844) (510) (fax) P.O. Box Oakland, CA Quality & Operations Support Professional Credentialing (510) Outside Medical Services Outside Services Case Management Emergency Prospective Review Program (EPRP) CA Statewide Service The HUB Nephrology Specialty Department Authorizations, Referrals by Service Referral Coordinators - Facility Listing - Section 2.6 Case Management by Service Facility Listing - Section 2.6 Emergency Notification Non-Emergency Ambulance and Medical Transportation Management of Adult Kidney Transplant patients 91 days and beyond after transplant (800) Available 24 hours a day, 7 days a week (800) San : (415) So. Sacramento: (916)

3 Department Area of Interest Contact Information National Transplant Network Transplants: All Other (510) (510) KP Outside Services Departments The Outside Services Department associated with each KP facility includes Referral Coordinators and Outside Services Case Managers who work closely with health care professionals who contract with KP. Referral Coordinators are your first contact for questions about authorized referrals. Referral Coordinators: Process and distribute authorization documents Verify status of authorizations Act as liaisons between the Provider and KP physicians Referral Coordinators may be reached by calling the telephone number that is provided on the authorization document. If you have not received an authorization document from us, contact the Referral Coordinator in your Service Area. For billing related questions, call Customer Service. Outside Services Case Managers address specific services and are your first contact to address Member care issues involving: Concurrent review and UM Discharge planning 2.6 KP Facility Listing KP Facilities and Outside Services Departments may be reached at the telephone numbers listed on the following pages. 6

4 SERVICE AREA GENERAL INFORMATION REFERRAL COORDINATORS RENAL CASE UTILIZATION MANAGEMENT East Bay Marin/Sonoma Greater San Service Area Oakland (510) (510) (510) (510) (510) Richmond (510) (510) (510) (510) San Leandro (510) (510) (510) (510) (510) Fremont (510) (510) (510) (510) (510) San Rafael (415) (415) (415) (415) West Marin/ Coastal Health (415) (415) (415) (415) Alliance Santa Rosa (707) (707) (707) (707) San (415) (415) (415) (415) So. San (650) (650) (650) (650) San Mateo Redwood City (650) (650) (650) (650) South Bay Santa Clara (408) (408) (408) (408) San Jose (408) (408) (408) (408) Diablo Walnut Creek (925) (925) (925) (925) Antioch (925) (925) (925) (925) Vacaville (707) N/A N/A (707) Vallejo (707) (707) (707) (707) Napa/Solano Vallejo Rehab- (707) N/A N/A (707) KFRC Sacramento (916) (916) (916) (916) North Valley/ Roseville (916) (916) (916) (916) S. Sacramento So. Sacramento (916) (916) (916) (916) Manteca (209) (209) (209) (209) Central Valley St. Joseph s Medical Center (209) N/A N/A N/A Modesto (209) (209) (209) (209) Fresno Fresno (559) (559) (559) (559) Out of Service Area (877)

5 SERVICE AREA East Bay Marin/Sonoma Greater San Service Area San Mateo South Bay Diablo Napa/Solano North Valley/ S. Sacramento Central Valley Fresno OUTSIDE SERVICES CASE MANAGEMENT HUBS SKILLED NURSING COORDINATOR Mon - Fri (8:30a - 5:00p) SKILLED NURSING COORDINATOR Evenings, Weekends & Holidays HOME HEALTH CASE HOSPICE CASE Oakland (925) (510) (877) (510) (510) Richmond (925) (510) (877) (510) (510) San Leandro (925) (510) (877) (510) (510) Fremont (925) (510) (877) (510) (510) San Rafael (925) (415) (877) (415) (415) West Marin/ Coastal Health Alliance (925) (415) (877) (415) (415) Santa Rosa (925) (707) (877) (707) (707) San (925) (415) (877) (415) (415) So. San Redwood City Santa Clara San Jose (650) (877) (415) (415) (650) (877) (650) (650) (408) (877) (408) (408) (408) (877) (408) (408) Walnut Creek (925) (925) (925) (925) (925) Antioch (925) (925) (925) (925) (925) Vacaville (925) (707) (707) (707) (707) Vallejo (925) (707) (707) (707) (707) Sacramento (916) (916) N/A (916) (916) Roseville (916) (916) N/A (916) (916) So. Sacramento (916) (916) (877) (916) (916) Manteca (916) (209) (209) (209) (209) Dameron (916) (209) (209) (209) (209) Modesto (916) (209) (209) (209) (209) Fresno Out of Service Area (877) (559) (559) (559) (559)

6 SERVICE AREA East Bay Marin / Sonoma Greater San Service Area PSYCHIATRIC HOSPITAL AUTHORIZATION/ NOTIFICATION: Weekdays PSYCHIATRIC HOSPITAL AUTHORIZATION/ NOTIFICATION: Evenings/Weekends PSYCHIATRIC CASE TRRS CASE Oakland (925) (925) (925) (510) Richmond (925) (925) (925) (510) San Leandro (925) (925) (925) (510) Fremont (925) (925) (925) (510) San Rafael (925) (925) (925) (707) West Marin/ Coastal Health Alliance (925) (925) (925) (707) Santa Rosa (925) (925) (925) (707) San (925) (925) (650) (415) So. San (925) (925) (650) (415) (415) San Mateo Redwood City (925) (925) (650) (408) South Bay Diablo Napa/Solano North Valley/ S. Sacramento Central Valley Santa Clara (925) (925) (650) (408) San Jose (925) (925) (650) (408) Walnut Creek (925) (925) (925) (510) Antioch (925) (925) (925) N/A Vacaville (925) (925) (925) N/A Vallejo (925) (925) (925) (707) Sacramento (925) (925) (916) Pager (916) Roseville (925) (925) (916) Pager (916) So. Sacramento (925) (925) (916) Pager (916) Manteca (925) (925) (209) (925) (209) Dameron N/A N/A N/A (209) Modesto (925) (925) (209) (209) Fresno Fresno (925) (925) Out of Service Area (925) (925) (559) (925) (559)