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  • Kaiser Permanente Member Reimbursement Claim Form

Get Kaiser Permanente Member Reimbursement Claim Form

MEMBER REIMBURSEMENT CLAIM FORM INSTRUCTIONS: This form is to request reimbursement for services youve paid for outofpocket. For your claim to be considered for payment, follow these simple steps: 1.

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Signature: Date: For any questions please contact Member Services toll-free at 1-888-901-4636, (TTY Relay: 711 or 1-800-833-6388). Or visit kp.org/wa, click on “Member Services” and send an email. Reimbursement requests will be processed within 60 days of receipt.

How do I get reimbursed for care I received on my trip? To submit a reimbursement claim for emergency or urgent care you received while traveling, sign in to kp.org and visit “Coverage & Costs.”1,2 If you don't have a kp.org account, or need assistance, call the Away from Home Travel Line at 951-268-3900 (TTY 711).

Documents Required for Filing Reimbursement Claim Health Card Copy. Duly Filled Claim Form. Original Hospital Discharge Summary. Investigation Reports like scans, X-rays, blood reports, etc. Cash Receipts from Hospitals. If an accident happens, then FIR or medico-legal certificate(MLC)

Call Customer Service at 1-800-788-0710 (TTY 711), Monday through Friday, 7 a.m. to 7 p.m., Pacific time.

By electronic delivery: Contact 866-921-5310 (toll free) for instructions on submitting electronic claims. You may now submit appeals online via the Online Affiliate portal. Sign on or Register to access KP Online Affiliate and start using this feature today.

What is a Direct Member Reimbursement (DMR)? At times, you may be required to submit a claim form and your receipts for reimbursement for prescriptions filled at a retail pharmacy. This process of reimbursing is called Direct Member Reimbursement, or DMR.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232