Verification of Benefits and Referrals

Verification of the member’s benefit coverage before treatment is critical. While the member may provide this information, the provider is responsible to verify the accuracy of the member’s coverage directly with CHP for Self-Referred members or Kaiser Permanente for Direct Referral members. This ensures the provider’s office is collecting the correct monetary amount from the member and provides clarity to the member about their out-of-pocket costs.

In cases where a Kaiser Permanente Primary Care Provider chooses to make a referral, it is very important that CHP providers have the referral in hand prior to services being rendered, and thoroughly review the referral noting the designated provider, number of visits allowed, period of time covered, specific services authorized, and the condition for which the member was referred.

To assist you in gathering complete eligibility information on a new patient prior to services being rendered, please refer to CHP’s Patient Eligibility Verification form. This form can also be found in your copy of CHP’s Billing Manual.