Verify coverage and prior authorization — tools & contact

Contracted providers: verify member eligibility using the Eligibility Inquiry tool and check prior authorization or medical necessity requirements with the Preauthorization Code Check tool. Non‑contracted providers: contact the Provider Assistance Unit at 1-888-767-4670 for verification and prior authorization information.

• Eligibility Inquiry tool — verify coverage for contracted providers
• Preauthorization Code Check tool — view prior authorization requirements and medical necessity review criteria
• Provider Assistance Unit — 1-888-767-4670 for non-contracted providers

Procedure authorizations do not cover standard E&M codes

Procedure authorizations explicitly exclude the standard E&M code range; obtain separate authorization/coverage confirmation for E&M services if required.

• Procedure authorizations do not include the standard E&M code range

Plan-specific coverage attribution

Coverage for the listed pediatric cardiology services and procedure code ranges is provided by Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc. (Kaiser Permanente).

• Coverage attribution: Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc.

Medical necessity and potential additional clinical review

All services must be considered medically necessary; certain services may also be subject to additional clinical review criteria and benefits are subject to the patient's medical coverage agreement and applicable limits.

• Medical necessity determination required for coverage or payment
• Some services may require additional clinical review criteria
• Refer to the patient's medical coverage agreement, Provider Manual, Provider contract, or call the Provider Assistance Unit at 1-888-767-4670 for coverage determinations