FAQs

Q: Who manages the provider directory?

A: Private Healthcare Systems (PHCS) is responsible for updating the network website.

• Providers/groups are responsible to inform PHCS of any network changes or updates.
• KPIC’s Network Management Team works with PHCS to resolve network issues.

Q: What if a member can’t locate a provider in the directory and they think they should be in the network?

Example: A new pediatrician joined the physician group that’s in the PHCS network. The pediatrician should be listed, but isn’t.

A: Most likely the physician group hasn’t notified PHCS of the new provider.

• Follow the escalation issue process.
• Network Management Team will work with PHCS to validate provider
• Goal is to have issue resolved within five business days and Website updated as quickly as possible

Q: What is the letter of agreement process?

A. The letter of agreement process (LOA) is an initiated arrangement with KPIC and non-contracted facilities to provide a member with network rates and avoid balance billing. Network management works directly with facilities.

There’s a separate administrative process for professional LOAs:

• KPIC Operations works with Dell to flag the claim so it’s processed at in-network benefit.
• Approval required from Network Management and provider needs to agree to terms.

Q: What can affect eligibility?

A: These are some of the requirements that can affect eligibility:

• Network inadequacy issue: member doesn’t have reasonable access to the in-network provider. (Health plans are required to provide a sufficient number of physicians in the contract.) Includes: PCP more than 15 miles or 30 minutes or Specialist more than 30 miles or 45 minutes.
• Medical necessity (determined by Permanente Advantage). Includes: PCP referral to see a specialist, PPO member self-referral. Upon approval by Permanente Advantage, they work with network management.

Q: How do I submit a request for letter of agreement (KPIC Provider Network Inquiry and Issue Resolution Form) on behalf of member?

A: Send request to PHCS Network Management Team.

• Submit request to sharee.barranco@kp.org
• Include the following information on the form: Patient name and medical record number (MRN), physician name and physician hospital, contracted provider/group name, date of service, description of issue.

Q: How do I resolve Rental Network Issues?

A: Use the escalation issue process to submit any rental network issue (excluding claims) to PHCS Network Management.

Submit Network Inquiry and Issue Resolution Form when escalating, located at HPI

Examples of issues:

• Network inadequacies: Submit LOA form with Network Inquiry and Issue Resolution Form
• Multiplan.com/Kaiser website questions/problems
• Provider issues: Member complains about provider, bad member experience.
• Network discrepancies: Provider not listed in directory. Balance billing.
• Request for large directories: Maximum query member/sales can create is 250 listing, provider network can create more extensive directory