Home
Forms Library
Kaiser permanente credentialing application

Kaiser credentialing application 2026

kaiser permanente credentialing application Preview on Page 1

See details

4.5 out of 5

27 votes

The document is a credentialing application for organizational providers seeking to join the Kaiser Permanente network. It outlines the necessary steps, required documentation, and submission guidelines for both initial credentialing and recredentialing. Key requirements include accreditation certificates, liability insurance, state licenses, and other relevant forms. The application must be completed electronically and submitted via email or mail to designated Kaiser Permanente addresses.

Here's how it works

01. Edit your kaiser permanente credentialing application online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out kaiser credentialing application with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the Kaiser Credentialing Application in the editor.
Begin by filling out the 'Organizational Provider/Facility Information' section. Select all applicable organization types, such as Acute Care Hospital or Behavioral Health Care Facility.
Next, complete the 'Demographics' section. Enter your facility name, address, phone number, Federal Tax ID Number, and NPI. Ensure all fields are filled accurately for a smooth processing.
Proceed to the 'Licensure' section. Provide your license type, number, and expiration date. If applicable, detail any actions taken against your license.
In the 'Medicare Certification' section, indicate your participation status and provide your Medicare Certification Number if certified.
Complete the 'Accreditation' section by indicating if you have any accreditations and providing relevant details as required.
Finally, fill out the 'Insurance/Claims' section with your professional and general liability insurance details. Ensure coverage meets minimum requirements specified in the instructions.

Start using our platform today to streamline your Kaiser Credentialing Application process for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I check my Kaiser eligibility?

Self-Service is available in the IVR System 24 hours per day, 7 days per week at (888) 576- 6789. Alternately, you may call the IVR system of the KP Member Services Contact Center to verify benefits and eligibility 24 hours per day, 7 days per week at: (888) 576-6789.

How to become a contracted provider with Kaiser Permanente Southern California?

If you are a Facility provider interested in contracting with Kaiser Permanente, please contact Network Development Administration. They can be docHubed at 626 405-3240 or ndanda-providerrelations@kp.org.

Does Kaiser use Caqh?

If you have an existing CAQH profile, please ensure you have authorized Kaiser Permanente to have access to your information. After entering all necessary data, select the Review Attest button to review your data and ensure its accuracy.

How do I check my Kaiser MFA status?

If you have any questions or need help with your application or need to check the status of your application, please call 1-800-390-3507 (TTY 711), Monday through Friday, 8:00 a.m. to 5:00 p.m., PST. You can also talk to a financial counselor at any Kaiser Permanente location.

Who is eligible for Kaiser Permanente in Hawaii?

Live in the Kaiser Foundation Health Plan, Inc. service area on Maui Island. You must live in a household with an annual income up to 300 percent of the Federal Poverty Level (FPL). For example, the 2023 FPL for Hawaii (annual income) is up to $50,310 for an individual or $103,500 for a household of 4.

Who qualifies as a dependent kaiser?

Dependents. All eligible dependents must enroll on the original effective date. Dependents will not be added for a later effective date unless newly eligible. Eligible dependents include legal spouse or domestic partner and unmarried children to age 19 or 25 if enrolled in an accredited school, college or university.

Who is eligible for Kaiser retirement?

Kaiser Foundation Health Plan (KFHP) To be eligible for KFHP in retirement, you must reside within the KFHP California service area, and: docHub age 55 with 15 or more years of Common Plan Qualifying Service, or. docHub age 65* with at least 10 years of Common Plan Qualifying Service, or.

How long does Kaiser credentialing take?

The entire process, including privileging, can take 10 - 12 weeks, sometimes longer if staff experience delays as outlined above.

Kaiser credentialing application 2026

Here's how it works