Kaiser Permanente Medicare Advantage
Also covers / subsidiaries: Kaiser Permanente, Kaiser, KP Senior Advantage
Core Payer & Clearinghouse Profile
Electronic Payer ID
10125
Payer ID varies by Kaiser region (N/S CA, CO, GA, HI, Mid-Atlantic, NW, WA). Kaiser is largely a closed integrated system; out-of-network/contracted claims routing varies by region.
Timely Filing Limit (TFL)
Per provider contract / regional rules; verify against the applicable Kaiser region
Appeal Window
Medicare Advantage appeals follow CMS Part C rules (commonly 60 days from the denial/organization determination)
Clearinghouse Gateway
National Clearinghouse / EDI Gateway
Provider Services
Varies — confirm via portal / clearinghouse
Claims Fax
Varies — confirm via portal / clearinghouse
Claims Address
Varies — confirm via portal / clearinghouse
Provider Portal
https://healthy.kaiserpermanente.org/
Kaiser offers Senior Advantage Medicare plans through its regional integrated systems. Payer IDs and processes differ by region.
National EDI Clearinghouse Capabilities
Direct ANSI X12 electronic transaction support verified for Kaiser Permanente Medicare Advantage.
Associated Clearinghouse Payer IDs
National clearinghouse networks maintain dedicated routing IDs for specific transaction lines or subsidiaries under Kaiser Permanente Medicare Advantage.
| Clearinghouse Name | Electronic Payer ID | Status | Enrollment | Supported Services |
|---|---|---|---|---|
| Edic | J1289 | Non-Par | None | Workers Comp |
| Edic | WB021 | Non-Par | None | Workers Comp |
| Medica | 10125 | Non-Par | None | 837P837I270/271276/277Dental |
| Medica | 94265 | Non-Par | Required | 837P837I835 ERA |
| Medicare | 00431 | Non-Par | None | 837P837I270/271Dental |
Resolution Tools for Kaiser Permanente Medicare Advantage Claims
Values vary by plan, line of business, and provider agreement. Confirm in the payer portal or with your clearinghouse gateway before submitting electronic claims.
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