Department Area of Interest Contact Information

Transcription

1 2. Key Contacts 2.1 Northern California Region Key Contacts KP MSCC Department Area of Interest Contact Information Medical Services Contracting Membership Information General enrollment questions Eligibility and benefit verification Co-pay, deductible and co-insurance information Members presenting without KP identification number Verifying Member s PCP assignment Member grievance and appeals Payment status on submitted claims Contract Network Development and Provider Network Management Updates to Provider demographics, such as Tax ID, address, and ownership changes Practitioner additions/terminations to/from your group Provider education and training Contract interpretation Form requests (888) (Member cost share and eligibility verification) Weekdays : 8a-5p Pacific IVR System available 24 hours / 7 days a week (844) (510) (fax) P.O. Box Oakland, CA Quality & Operations Support Practitioner Credentialing (510) Medical Services Contracting Facility/Organizational Provider Credentialing (844) Medical Staff Office Kaiser Foundation Hospital Privileges Facility Listing Section 2.4 Outside Medical Services National Claims Administration Authorizations, Referrals by Service Authorizations, referrals & billing questions for referred services Coordination of Benefits Third Party Liability Workers Compensation Emergency Medical Claims (non-medicare) Billing questions for emergency (non-referred) services Emergency Medical Claims (Medicare) Billing questions for emergency (non-referred) services Referral Coordinators - Facility Listing - Section 2.4 (800) P.O. Box Oakland, CA (800) PO. Box Oakland, CA

2 Department Area of Interest Contact Information Outside Services Case Management Case Management by Service Facility Listing - Section 2.4 Department of Research Clinical Studies (510) Clinical Reviews Emergency Prospective Review Program (EPRP) CA Statewide Service The HUB Nephrology Specialty Department National Transplant Network UM Reconsiderations and Appeals 72 Hour Expedited Appeals Emergency Notification Non-Emergency Ambulance and Medical Transportation Management of Adult Kidney Transplant patients 91 days and beyond after transplant Transplants: All Other (888) (888) (fax) M-F 7am-7pm; Sat 9am-1pm (800) Available 24 hours a day, 7 days a week (800) San : (415) So. Sacramento: (916) (510) (510) Member Services Interactive Voice Response System (IVR) KP Member Services IVR can assist you with a variety of questions. Call (888) 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 status of a Member s accumulator (amount applied toward deductible); claims and payment status; or connect you to a Member Services Contact Center (MSCC) representative. Follow the prompts to access these services. 2.3 KP Outside Services Referral Coordinators and Outside Services Case Managers work directly with Plan Physicians to authorize services to Providers. The Member Services Contact Center (MSCC) is your first contact for questions about authorized referrals and billing information, such as:

3 Referral status Services and Dates Authorized Claims status Covered Benefits, Covered Services and Member Cost Share questions Questions concerning pending authorizations and scope of services details will be routed by MSCC to the Referral Authorization Hub. Inquiries or requests for additional services by Providers will be routed to the referring Plan Physician. 2.4 KP Facility Listing KP Facilities, Referral Coordinators and Outside Services Case Managers may be reached at the telephone numbers listed on the following pages

4 SERVICE AREA GENERAL INFORMATION REFERRAL COORDINATORS RENAL CASE MANAGERS UTILIZATION MANAGEMENT Oakland (510) (510) (510) (510) (510) Richmond (510) (510) (510) (510) East Bay (510) San Leandro (510) (510) (510) (510) Fremont (510) (510) (510) (510) (510) San Rafael (415) (415) (415) (415) Marin/Sonoma West Marin/ Coastal Health (415) (415) (415) (415) Alliance Santa Rosa (707) (707) (707) (707) Greater San San (415) (415) (415) (415) Service Area 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 North Valley/ S. Sacramento Central Valley Sacramento (916) (916) (916) (916) Roseville (916) (916) (916) (916) So. Sacramento (916) (916) (916) (916) Manteca (209) (209) (209) (209) 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 OUTSIDE SERVICES CASE MANAGEMENT HUBS SKILLED NURSING COORDINATOR Mon - Fri (8:30a - 5:00p) SKILLED NURSING COORDINATOR Evenings, Weekends & Holidays HOME HEALTH CASE MANAGERS HOSPICE CASE MANAGERS East Bay Marin/Sonoma Greater San Service Area San Mateo South Bay Diablo Napa/Solano North Valley/ S. Sacramento Central Valley 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 So. San Redwood City Santa Clara San Jose (925) (415) (877) (415) (415) (408) , Option 1 (408) , Option 1 (408) , Option 1 (408) , Option 1 (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) St. Joseph s Medical Center (916) (209) (209) (209) (209) Modesto (916) (209) (209) (209) (209) Out of Service Area (877)

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

7 Addiction Medicine Recovery Services (AMRS) Day Treatment Programs Service Area Facility Department Number Program Director/Manager Address Central Valley Manteca Ester Baldwin Modesto Stockton Tracy Diablo Antioch Marilyn O Connor Marilyn.O.O'Connor@kp.org Martinez Pleasanton Walnut Creek East Bay Oakland Noel Legorburu Noel.S.Legorburu@kp.org Richmond Fresno Fresno Michael Nunes Michael.A.Nunes@kp.org Greater Southern Alameda Fremont Union City Jennifer Miller Jennifer.K.Miller@kp.org Napa/Solano North Valley San Santa Clara Santa Rosa Petaluma/San Rafael Vallejo Vacaville Roseville Sacramento South Sacramento Redwood City San San Rafael South San Redwood City San Jose Santa Clara Santa Cruz San Rafael Santa Rosa Kurt Meyers Kurt.A.Meyers@kp.org Kristy Schwee Kristy.N.Schwee@kp.org Sofia Gonzalez Sofia.N.Gonzalez@kp.org H.B.(Tresy) Wilder H.B.Wilder@kp.org Christopher Evans Christopher.S.Evans@kp.org

8 2.5 Northern California Resource Management (RM) Contacts Coordination of Care Service Directors (COCSD), UM/RM Managers, and Social Workers may be reached at the telephone numbers listed on the following pages. Location Address COCSD UM/RM Manager Social Worker Antioch Fremont Fresno Manteca Modesto Oakland Redwood City Richmond Roseville Sacramento San San Jose San Leandro San Rafael 4501 Sand Creek Road Antioch, CA Paseo Padre Pkwy Fremont, CA North Fresno Street Fresno, CA West Yosemite Ave Manteca, CA Dale Road, Ste 1H7 Modesto, CA West MacArthur Blvd Oakland, CA Veterans Blvd Redwood City, CA Nevin Avenue Richmond, CA Eureka Road Roseville, CA Morse Avenue Sacramento, CA 2425 Geary Blvd San, CA Hospital Parkway San Jose, CA Merced Street San Leandro, CA Montecillo Road San Rafael, CA Lynn McClough (925) Sharon D. Johnson (510) Michelle Garcia- Wilkins Julie Ann Gist (209) Julie Ann Gist (209) Janet McBride (510) Maria-Teresa B. Guadarrama (650) Janet McBride (510) Dee Ford (916) Linzy Davenport (916) Margaret Williams (415) ext Kelli Suto (408) Irina Y. Lewis Denise Laws (415) Catherine De Castro (925) Sharon D. Johnson (510) Katrina Hernandez (559) Lisa Moshiri (209) Malou Catuira (209) Charles Brigham (925) Jenny Vo (510) Iris Young (559) Debbie Vieira (209) Debbie Vieira (209) Bernadette Navarra- Yee (510) VACANT Jeffrey Trinidad (510) Marsha Belen (650) Heather Rodriguez (510) Brenda Dabovich (916) Kathleen Steele (650) Nancy Jacobson (510) Erica Menzer (916) David J Thomas VACANT (916) Juliet Pacaldo (415) VACANT Kelli Suto (408) Elsamma Babu (510) Taira Roder (415) Greg Dalder (408) Clay Van Batenburg (510) Ruth Vosmek (415)

9 Location Address COCSD UM/RM Manager Social Worker Santa Clara Santa Rosa South Sacramento South San Stockton Vacaville Vallejo Vallejo Rehab Walnut Creek 700 Lawrence Expressway Dept. 312 Santa Clara, CA Bicentennial Way Santa Rosa, CA Bruceville Road, South Sacramento, CA El Camino Real South San, CA N California St Stockton, CA One Quality Drive Vacaville, CA Sereno Boulevard Vallejo, CA Sereno Boulevard Vallejo, CA South Main Street Lilac Building #29 Walnut Creek, CA Victoria Weisgerber (408) Denise Laws (707) Mary Jo Schmidt Margaret Williams (415) ext Julie Ann Gist (209) Brandon Pace (707) Anh-Tu Nguyen (707) Anh-Tu Nguyen (707) Lois Hogan (925) Samantah Rahel Collier-Webb (408) Carrie Bibb (408) Cynthia Boter (707) Kaprice Sistrunk (916) Martha Searle (505) Lisa Moshiri (209) Deborah Aragon (7070) Camille Vilce (707) Catherine Cyr (707) Miraslava Harter (925) George Fogle (408) Diane Sloves (707) Jennifer Park (916) Sharmila Grant (650) N/A Charlotte Richardson (707) Jean Broadnax (707) Carol McMenamy (925) Serge Teplitsky Regional Contracting Administrator (650) (cell) Alicia Ballantyne Clinical Practice Consultant (707) (cell) Resource Management Functional Unit 1950 Franklin Street, 12 th Floor Oakland, CA Marie Holtz Consultant (510) (cell) Vernester Sheeler Consultant (510) (cell) Jennifer Witt Project Manager (cell) Health Plan Utilization Management Sandy P. Williams, RN, BSN, MBA Managing Director (510)