Neighbor Island Medical Service Network Chapter 8: … · Direct access to the contracted primary specialties of Ob/Gyn, ... Neighbor Island Medical Service Network 5 ... inguinal

Kaiser Permanente Provider Manual Chapter 8: Neighbor Island Medical Service Network 1

Neighbor Island Medical Service Network Chapter 8: Kauai, Lanai, and Molokai


Delivery System Kauai, Lanai, System Kauai, This section of the Manual was created to help guide you and your staff in working with Kaiser Permanente’s Neighbor Island Networks delivery system. It provides a quick and easy resource with contact phone numbers, detailed processes and site lists for Authorization Referral Management Services. If, at any time, you have a question or concern about the information outlined in this section, you can reach our Neighbor Island Networks Administration Department by calling the Administrator, Affiliate Provider Relations at 808-271-7614.

Neighbor Island Networks Delivery

System Kauai, Lanai, and Molokai


KAISER PERMANENTE

Table of Contents

CHAPTER 8: NEIGHBOR ISLAND NETWORK DELIVERY SYSTEM ............................... 4 8.1 Primary Care ........................................................................................................................................... 4 8.2 Specialty Care ......................................................................................................................................... 4

Authorization/Referrals ................................................................................................................................................. 5 8.3 Network Self-Referral ............................................................................................................................. 5 8.4 Referral Care Directions ........................................................................................................................ 5 8.5 Kauai Network Referral Process and guidelines ................................................................................ 7 8.6 Molokai Referral guidelines ................................................................................................................. 14 8.7 Lanai Referral guidelines..................................................................................................................... 15 8.8 Out of Plan/Referral .............................................................................................................................. 16 8.9 Denied Authorizations ......................................................................................................................... 16

Admissions/Hospital Care/Emergency Services .................................................................................................. 16 8.10 Emergency Services .......................................................................................................................... 16 8.11 Admissions to Network Hospitals on Kauai, Molokai and Lanai .................................................. 17 8.12 Scheduled Inpatient Admission and Services ................................................................................ 17 8.13 Hospital Transfer to Kaiser Permanente, Moanalua (MOA) ........................................................... 17

8.14 Continuing Care ................................................................................................................................................... 18 • Skilled Nursing Facility (SNF) .......................................................................................................... 18 • Home Health ....................................................................................................................................... 18 • Hospice services ............................................................................................................................... 18 • Durable Medical Equipment, Braces, and Prosthetic Devices ..................................................... 18

8.15 Pharmacy ............................................................................................................................................................... 18

8.16 Claims and Appeals ................................................................................................................................ 18


KAISER PERMANENTE

Chapter 8: Neighbor Island Network Delivery System The Islands of Kauai, Molokai and Lanai are unique and valuable addition to Kaiser Permanente’s Statewide HMO. They are a network model locally (on each respective island), supported and augmented by the full array of specialty and tertiary services of the Kaiser Hawaii Region, including access to a tertiary multi-specialty referral Kaiser Foundation Hospital facility on Oahu. The Neighbor Island Network Delivery systems are comprised of several layers, designed to provide the highest level of care and ready access to services in the most appropriate fashion considering availability, quality, urgency, medical necessity and cost effectiveness. 8.1 Primary Care Kaiser Permanente has contracted with multiple primary care providers on Kauai, Molokai and Lanai to care for our members on each island. These PCP’s are directly accessible to the members for all needed primary care as well as overall integration and management including coordination of specialty care and referrals. PCP’s may be Internists, Family Physicians, or Pediatricians. Direct access to the contracted primary specialties of Ob/Gyn, Optometry, and Ophthalmology allow for our members to seek these services without referral, although co-ordination of their overall medical care with their PCP is encouraged (see Clinician Listing on kp.org: https://healthy.kaiserpermanente.org/static/health/en-us/pdfs/hi/HMODirectory_Kauai_Lanai_Molokai.pdf). 8.2 Specialty Care Specialty care is provided where most appropriate to the particular clinical situation. Kaiser Permanente regional clinical guidelines are utilized to guide care and assure full pre-specialty visit evaluations to maximize their efficacy. Urgent and emergent care is delivered on Island by contracted, credentialed providers. Routine and elective care is provided, either on Island or on Oahu, depending on availability of specialist and services, including access to subspecialty care available only at Kaiser Moanalua. Every effort is made to afford our Kaiser Permanente members on Kauai, Molokai and Lanai with full access to all Kaiser Permanente Hawaii providers and services. When care is delivered on Kauai, Molokai and Lanai, Kaiser Permanente pays for these services for our members if covered by auto authorization criteria or after referrals have been authorized by the relevant Kaiser Permanente department chair. When care is directed to Kaiser on Oahu, either due to availability, or for improved quality of care, Kaiser

https://healthy.kaiserpermanente.org/static/health/en-us/pdfs/hi/HMODirectory_Kauai_Lanai_Molokai.pdf

https://healthy.kaiserpermanente.org/static/health/en-us/pdfs/hi/HMODirectory_Kauai_Lanai_Molokai.pdf


KAISER PERMANENTE

Permanente assumes the cost of patient travel as an administrative concession to our Kauai, Molokai and Lanai members to remove this barrier to their ability to access care. KAISER PERMANENTE Referrals for care not available within Kaiser Permanente Hawaii Permanente Medical Group (HPMG), either in Hawaii or on the mainland, is handled as with all such regional referrals through established referral guidelines, practices and channels. Hospital and urgent/emergent care is available on Kauai at Wilcox Memorial Hospital, Samuel Mahelona Hospital and Kauai Veterans Memorial Hospital (KVMH); on Molokai at Molokai General Hospital; on Lanai at the Lanai Community Hospital. Specialty hospital care is directed and/or transferred to KP Moanalua Hospital (MOA). Ancillary services are available via contracts locally with appropriate providers for such services as Home Health, SNF, Lab, DI, Hospice, DME, Pharmacy, etc. This manual will explain the Neighbor Island Network Delivery System in some detail as well as how it connects and relates to the KP HI region as a whole. It is meant to be a guide and directory only and not a rigid delineation of how to manage any particular patient. To that end, the names, specialties, and contact numbers of HPMG providers and resources are included – direct contact between Neighbor Island Network providers and Kaiser Permanente is encouraged, especially as it relates to specific concerns regarding specific patients or circumstances. Authorization/Referrals 8.3 Network Self-Referral At Kaiser Permanente, you don't need a referral or pre-authorization to make appointments for the following services and departments within the network. See listing of clinicians at Kp.org.

• Alcohol and drug treatments • Behavioral Health Services • Eye Examinations for glasses and contact lenses • Family Practice • Health Education • Internal Medicine • Medication Counseling • Obstetrics/Gynecology • Occupational Health Services • Pediatrics • Social Work • Travel Medicine

8.4 Referral Care Directions

KAISER PERMANENTE

All physicians have at times found the need to consult with another physician regarding their patient’s care. At Kaiser Permanente, we value the services of our Affiliated Network Practitioners who, in partnership with our own physicians, provide our members with the highest quality of care available. These directions are intended to be a helpful resource for you when managing patients. These documents contain information provided to you by the Kaiser Permanente Chiefs for each Specialty in partnership with the Neighbor Island Network Physician-in-Charge. Contact the Authorizations and Referral management for info about authorization procedures including denials and appeals. Phone: 1-800-432-5687 Mon-Fri 8am-5pm Fax: 808-432-5691 or 808-432-5667

• Authorization are valid for 3 months but may vary • PCP may extend the authorization with a valid authorized referral. • Only one (1) visit or service is allowed per authorization, unless otherwise indicated.

The number of visits or services will vary depending on type of service. • Each authorization has a unique authorization number. This authorization number

must be reflected on the claim/bill to receive appropriate processing and payment. • The authorization form is valid only if:

o The Member is eligible on the date of service and o The Member has the benefit which covers the stated condition

Please refer to chapter 17 of the Affiliated Practitioner manual for additional information. A copy of the referral form is available on the Community Provider Portal Hawaii region website:

Log in: http://providers/kaiserpermanente.org/hi/index.html Kaiser Permanente Provider Manual Chapter 8: Neighbor Island Medical Service Network

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KAISER PERMANENTE

8.5 Kauai Network Referral Process and guidelines

Kaiser Permanente Provider Manual Chapter 8: Neighbor Island Medical Service Network

7

Kauai Network Referral Authorization. Rev 8/18/2015

ARM = Authorization Referral Management Phone: (808) 432-5687, Fax (808) 432-5691, Alternate Fax (808) 432-5667* Applicable Additional Form Required with Referral

Each Referral/Authorization Requires Applicable: 1)Progress Notes 2)Labs 3)X-rays and Tests 4)Appropriate Kaiser Order Form

No Auth Required

for care to stay in

network on Kauai

Referral Auth Required.

Fax to ARM Dept

432-5691

Direct to KP MOA Specialty

Clinics. Fax to MOA Schedulers 432-7878

Preferred Network Providers

Routine care for diagnosis and treatment xKauai Medical Clinic (HPH) Dr. John FunaiDr. Andrew So

All other Cardiology Care, send Ref for Consult to MOA (may include specific Cardiology testing recommendations in referral notes)

x

Dx/Tx of actinic keratoses xBiopsy to r/o skin cancer xElliptical excision of non-melanoma skin cancer xRecalcitrant or generalized rashes xVesicular or bullous rashes xDrug eruptions xSevere acne xWarts xAll other Dermatology Care send to Kaiser. x

General X-ray x

Mammography - Screening CPT 77057 x

Ultrasound Level 1 for OB First Trimester-CPT 7680 xHHSC West Kauai Clinic Dr. Surachat Chatkupt, Dr. Graham Chelius

All other Diagnostic Imaging Ref, send to Kaiser MOA. x Complete MRI form with MRI

referrals.

For Urgent Referrals:--Call Kaiser MOA (808)432-0000 Ask for Specialist On-Call (indicate who you spoke to on Referral form) --Care directed to KP MOA, fax Referral Authorization form to MOA schedulers at (808)432-7878 --Care directed to stay on Kauai: Fax Referral Authorization form to ARM (808)432-5691 NOTE: Urgent Care Available on Kauai does NOT require pre-Authorization Approval. Send Referral form as fax notification to ARM (808)432-5691 to ensure payment of claims

Anytime services requested to stay on Kauai that are not listed under "No Auth Required" column, fax Referral authorization form to ARM dept (808) 432-5691

Kauai Dermatology Dr. Thomas Potter

Wilcox Memorial HospitalKauai Veterans Memorial Hospital (KVMH)

Cardiology (18 years and older) KP Chief, Dr. Kevin Kwaku MD to MD hotline 432-7239

Dermatology KP Chief, Dr. Theresa Devere MD to MD hotline: 432-0000 page through operator

Diagnostic Imaging KP Chief, Dr. Daniel Henshaw DI Call center 432-5502

KAISER PERMANENTE





No Auth Required

for care to stay in

network on Kauai


Fax to ARM Dept

432-5691




All Outpatient Home DME x APRIAExternal Orthotics and Prosthetics x

Routine care for diagnosis and treatment xElective Surgery - T&A, etc. xKP Care as necessary xAll other ENT Care send to Kaiser MOA. x

Routine care for diagnosis and treatment x Kauai Medical Clinic (HPH) Dr. Ellioit Morris

All other GI Care (including procedures) x

Benign breast lesions, breast biopsies xElective laparoscopic cholecystectomies xElective outpatient, inguinal hernia xEvaluations for possible surgical cases, preop wo xFemoral hernia, small umbilical xInitial ventral hernia xLaceration repairs xMinor excisions, lumps and bumps xProcedures xRoutine surgical care xAll other General Surgery Care send to Kaiser MOA. x

Asthma Management xDiabetes Education x

Nutrition Management x

x Kauai Hospice

Routine care for diagnosis x Kauai Medical Clinic (HPH) Dr. James Yoon

All other Infectious Disease care send to Kaiser MOA. x

Urgent & After Hours DME Referrals Only - Call 1 (800) 481-0178

Durable Medical Equipment (DME) KP DME dept ph: 432-5692, fax 432-5691

Kauai Medical Clinic (HPH) Dr. Harold NetzerDr. Jay Murphy

ENT (Otolaryngology) KP Chief, Dr. Luca Vassalli MD to MD hotline: 432-8246

General Surgery KP Chief, Dr. Mark Yamamura MD to MD hotline: 432-8264

HHSC West Kauai Clinic - Dr. Elisabeth Biuk-Aghai Dr. Emilia Dauway-WilliamsDr. Connie Lutkevich

Health Management

Kauai Medical Clinic (HPH) Rhonda Pabo, FNP Don Traller, PA-C

Gastroenterology (GI) KP Chief, Dr. Daryl Fujiwara MD to MD hotline: 432-5785

Hospice

Infectious Disease KP Chief, Dr. Tarquin Collis MD to MD hotline: 432-7275

KAISER PERMANENTE





No Auth Required

for care to stay in

network on Kauai


Fax to ARM Dept

432-5691




Routine care for diagnosis and treatment xIP Care xOn-going care of CRF patients xDialysis - chronic Hemodialysis and CAPD x Liberty Dialysis

All other Nephrology care send to Kaiser MOA. x

Routine care for diagnosis and treatment x Kauai Medical Clinic (HPH) Dr. Surendra Rao

Procedures and all other Neurology care send to Kaiser MOA. x

Routine care for diagnosis and treatment x1st Trimester Ultrasound Level 1- CPT 76801 (outpt in clinic) x

Biopsy xColposcopy xRoutine Gyn Surgery xInitial Infertility evaluation and treatment xITOP (RH factor test result required with referral) x Planned ParenthoodIVF, Reproductive Endocrinology - (IVF Testing Form Required) Kaiser OB/Gyn 1st visit. x x Kaiser MOA OB GYN 1st visit

Pregnancy (OB) Services at KMC, EXCEPTION w/auth (lives north of Lihue) includes L&D w/criteria

x

Kauai Medical Clinic (HPH) Dr. Carol FujiyoshiDr. Robert MathisDr. David McDonaldDr. Erin Waters

All other OB/Gyn care send to Kaiser MOA. x

Routine eye care and conditions requiring chronic medical management. x

Routine eye examinations and preventive services as well as the required eyeglasses and contact lenses, according to Member’s benefit. Preventive services must follow Kaiser’s clinical guidelines and referral directions.

x

OB/Gyn KP Chief, Dr. Mabel Wong MD to MD hotline: 432-2599

Nephrology KP Chief, Dr. Alan Lau MD to MD hotline: 432-7841

Kidney Care of Hawaii Dr. Niraj DesaiDr. Aaron Nada

Neurology KP Chief, Dr. Todd Devere MD to MD hotline: 432-0000 page through operator

HHSC West Kauai Clinic Dr. Surachat Chatkupt Dr. Graham CheliusVirginia Beck, NP

Ophthalmology KP Chief, Dr. Dean Hu MD to MD hotline:432-2655 or 432-2600

Dr. Timothy Crane Dr. Timothy LeeDr. Gardener QuartonDr. Jean Shein Dr. Larry Sherre

KAISER PERMANENTE





No Auth Required

for care to stay in

network on Kauai


Fax to ARM Dept

432-5691




Cataract Surgery x

All medically necessary contact lenses and exams for keratoconus related care require an Authorization, and is based on member’s benefit. Medically necessary contact lenses appliances are ordered and provided by Kaiser Optical Department. Call 1-866-424-7908 for authorization.

x

All other Ophthalmology care send to Kaiser. x

Routine eye examinations and preventive services as well as the required eyeglasses and contact lenses, according to Member’s benefit. Preventive services must follow Kaiser’s clinical guidelines and referral directions.

x

Eye conditions requiring chronic medical management, including but not limited to glaucoma, chronic/recurrent infectious or inflammatory diseases and other similar conditions shall be referred directly to a Kaiser Affiliated Ophthalmologist.

x

All medically necessary contact lenses and exams for keratoconus related care require an Authorization and are based on member’s benefit. Medically necessary contact lenses appliances are ordered and provided by Kaiser Optical Department. Call 1-866-424-7908 for authorization.

x

All other Optometry care send to Kaiser. x

Routine Care for diagnosis and treatment x

Evaluation of general orthopedic problems. xEvaluation of possible surgical cases, pre-op wor xHardware removal xCommon hand cases, ex: carpal tunnel, ganglions, trigger finger releases x

Arthroscopy - knee (non-ACL) xArthroscopy - knee (ACL) & shoulder xArthoplasty - shoulder, hip, knee x

Optometry KP Chief, Dr. Kaylin Young MD to MD hotline: 432-2655 or 432-2600

Dr. Glenn BelisleDr. Layne HashimotoDr. Jere LooDr. Stacey MorinagaDr. Chet MyersDr. Michael Oride Dr. Timothy Crane Dr. Timothy LeeDr. Joel PunzalDr. Gardener QuartonDr. Jean Shein Dr. Larry Sherrer

Orthopedics KP Chief, Dr. Robert Shin MD to MD hotline: 432-8310

Kauai Medical Clinic (HPH) Dr. Derek JohnsonDr. David RovinskyDr. Alyssa SchaffersDr. Richele Takemoto

KAISER PERMANENTE





No Auth Required

for care to stay in

network on Kauai


Fax to ARM Dept

432-5691




All other Orthopedic care send to Kaiser MOA. x

Routine care for diagnosis and non-surgical trea xAll IP surgery. xAmbulatory Surgery Center care is limited to bunion/toe surgery x

Bunions and Bunionettes xDiabetic ulcer debridement xFoot/heel pain, NOS xHallux rigidus xHammer and claw toes xIngrown nails xMetatarsalgia xPlantar Fascitis xPlantar neuroma xAll other Podiatry care send to Kaiser MOA. x

xKauai Medical Clini (HPH) Dr. Heather Hopkins

Initial Eval & Care Plan - Rehab Form Required x

Treatment Plan and Therapy- requires typewritten notes for further auth'd visits x

Routine care for diagnosis and treatment xElective surgery as IP or in ASC. xManagement of stones, obstruction, etc. xOngoing care of chronic problems. xOutpatient surgery, such as vasectomies, etc. x

Radiation Therapy x Cancer Ctr of Hawaii

All other Urology care send to Kaiser MOA. x

Podiatry KP Chief, Dr. Earl Wong MD to MD hotline: 432-8310

Specialty Care not listed MD to MD hotline: Call KP MOA operator 432-0000 (ask to page requested specialist on call)

Kauai Medical Clinic (HPH) Dr. Tyler Chihara

Physical/Occupational/Speech TherapyKVMHSam Mahelona Hospital Rusty Cottrell Action Physical TherapyCheryl ClaypoolJon RiderTodd Strong

Urology KP Chief, Dr. Michele Aspera MD to MD hotline: 432-8240

Kauai Medical Clinic (HPH)

PhysiatryKP Chief, Dr. Merle Miura-AkamineMD to MD hotline: 432-7460

KAISER PERMANENTE

Kaiser Permanente Provider Manual Chapter 8: Neighbor Island Medical Service Network12




No Auth Required

for care to stay in

network on Kauai


Fax to ARM Dept

432-5691




All other Specialty care send to Kaiser MOA Allergy Oncology Plastic Surgery Pulmonary Rheumatology Vascular

x


KAISER PERMANENTE


KAISER PERMANENTE

8.6 Molokai Referral guidelines, rev 5/23/13 For Urgent Referrals: --Call Kaiser MOA (808)432-0000 Ask for Specialist On-Call (indicate who you spoke to on Referral form)

NOTE: Urgent Care Available on Molokai does NOT require pre-Authorization Approval. --Send Referral form as fax notification to ARM (808)432-5691 to ensure payment of claims

Services Provided on Molokai - NO auth required Family Medicine Internal Medicine Pediatrics Ob-Gyn Optical BHS Lab General Xray Screening Mammo OB Level 1 U/S

Services Provided on Molokai - Pre-Auth Required.

Fax Referral form to Authorization Referral Management (ARM) Dept Phone: 432-5687 Fax: 432-5691 Alt Fax: 432-5667 OT PT Home Care Hospice Dialysis Dexa

Durable Medical Equipment (DME)

Fax Referral form to Kaiser DME Phone: 432-5692 Fax: 432-5691

Urgent & After Hours DME Referrals Only, call 1 (800) 481-0178

All other services to be provided on Oahu

Fax Referral form to Authorization Referral Management (ARM) Dept Phone: 432-5687 Fax: 432-5691 Alt Fax: 432-5667


KAISER PERMANENTE

8.7 Lanai Referral guidelines, Rev 5/23/13

For Urgent Referrals: --Call Kaiser MOA (808) 432-0000 Ask for Specialist On-Call (indicate who you spoke to on Referral form)

NOTE: Urgent Care Available on Lanai does NOT require pre-Authorization Approval. --Send Referral form as fax notification to ARM (808)432-5691 to ensure payment of claims

Services Provided on Lanai - NO auth required Primary Care (FM, IM) Lab

General Xray Note: Screening Mammo and Dexa done on Oahu - Fax referral to ARM

Services Provided on Lanai - Pre-Auth Required Fax Referral form to Authorization Referral Management (ARM) Dept Phone: 432-5687 Fax: 432-5691 Alt Fax: 432-5667 OT PT Dialysis

Durable Medical Equipment (DME)

Fax Referral form to Kaiser DME Phone: 432-5692 Fax: 432-5691

Urgent & After Hours DME Referrals Only, call 1 (800) 481-0178

Behavioral Health Services (BHS) - care provided on Oahu

Call 1(888)945-7600

All other services to be provided on Oahu Fax Referral form to Authorization Referral Management (ARM) Dept Phone: 432-5687 Fax: 432-5691 Alt Fax: 432-5667


KAISER PERMANENTE

8.8 Out of Plan/Referral Please refer to chapter 17 of the Affiliated Practitioner manual. 8.9 Denied Authorizations The following could be reasons an authorization was denied:

• Services are deemed not medically appropriate. • The patient does not meet membership eligibility requirements. • The request for services is not a covered benefit or the benefit is exhausted. • Services were performed without prior authorization. • Refusal to use Participating Providers

Service requests are authorized when medical necessity has been established for a health care service and the services are covered under the Member’s contract. If the services requiring authorization are not approved: The requesting Participating Provider will be notified verbally within 14 business days of the decision to deny and by written communication within 14 business days of the decision. KAISER PERMANENTE If you are requesting reconsideration of a service denial on behalf of the Kaiser Permanente Member, you should contact Authorization Referral Management Department at (808) 243-6679. If more than 24 hours has elapsed, you or the Member must file a formal grievance in order to obtain further review. Admissions/Hospital Care/Emergency Services 8.10 Emergency Services See chapter 7 of the Affiliated Practitioner manual for additional information.

PERMANENTE On Kauai:

• Wilcox Memorial Hospital • Kauai Veteran's Memorial Hospital • Samuel Mahelona Hospital

On Molokai:

• Molokai General Hospital On Lanai:

All members should be directed to the nearest emergency facility. Coverage for emergency care is based on member's health plan eligibility and benefit coverage at the time of service.


KAISER PERMANENTE

• Lanai Community Hospital 8.11 Admissions to Network Hospitals on Kauai, Molokai and Lanai The Affiliated Network Hospital Staff is to notify Kaiser Permanente within 24 hours of admission, or the next business day by calling our Hospital Operation Center (HOC) at (808) 432-0000 or (800) 227-0482 AND faxing the admission face sheet to (808) 432-7251. At the time of the call, HOC will need to know the following information:

• Patient’s name • Patient’s medical record number • Patient diagnosis • Attending physician’s name • Bed status (i.e., CCU, telemetry, med surg) • Admission date • Type of admission (if the admission was generated from an emergency room visit or

if it as a regular direct admission) The participating hospital and/or facility are also responsible for notifying KP of all inpatient emergency admissions. Calls must be received within 48 hours of the admission. Failure to notify Kaiser Permanente within this time frame may result in the denial of authorization and denial of payment for services. If the admitting physician is not the Participating PCP, it is the admitting physician’s responsibility to contact the Participating PCP in order to authorize the admission and discuss plans for care. 8.12 Scheduled Inpatient Admission and Services For scheduled admissions, the Affiliated Network staff should contact the appropriate O'ahu-based Kaiser Permanente physician. The Kaiser Permanente physician and staff will coordinate the admission process, which may involve a pre-admission admit trip to O'ahu for pre-admission evaluations and consents in accordance with the Kaiser Permanente Neighbor Island Travel Policy. Travel inquiries by patients or providers called in to the Travel Inquiry line at (800) 214-6572. 8.13 Hospital Transfer to Kaiser Permanente, Moanalua (MOA) Who do I call?

• Contact the Nursing Supervisor at MOA • Direct line is 432-7743 • If no answer call 432-0000 and ask for the Nursing Supervisor • Provide: patient demographics, diagnosis and anticipated needs, current level of

care and any additional pertinent medical history.

The Supervisor will: • Determine if MOA has the capacity and capability to provide the required care. • Contact a MD with MOA admitting privileges and have them return your call to

discuss the case and accept the patient transfer


KAISER PERMANENTE

Transfer Guidelines

• EMTALA o Receiving facility must have capacity and capability to support the care

requirements of the patient o Supervisor accepts the capacity and capability o Physician accepts for medical care

Transport • Referral facility determines stability for transfer- "anticipated that no material

deterioration in patient condition will take place during transfer" • Referral facility arranges the mode of transport that appropriately supports the level

of care throughout the transfer process. This may mean the facility needs to provide adequately trained staff to accompany transport personnel to support the care needs of the patient. E

o Kapiolani Transport Team 1-808-983-8662o AMR Ground: 1-888-818-2970o AMR Air: Call the Kaiser Hospital Operations Center at 808-432-7745

• For pre-planned transfers (greater or equal to same day notification) to an O'ahu facility, please call the Transfer Coordinators during clinic hours at (808) 432-7252.

KAISER PERMANENTE 8.14 Continuing Care See chapter 9 of the Affiliated Practitioner manual regarding:

• Skilled Nursing Facility (SNF) • Home Health • Hospice services • Durable Medical Equipment, Braces, and Prosthetic Devices

8.15 Pharmacy See chapter 9 of the Affiliated Practitioner manual regarding consumer drug formulary. See the Community Provider Portal Hawaii region for additional pharmacy information

Log in: http://providers/kaiserpermanente.org/hi/index.html 8.16 Claims and Appeals See chapter 11 of the Affiliated Practitioner manual regarding claims. See the Community Provider Portal Hawaii region for additional claims and appeals information

Log in: http://providers/kaiserpermanente.org/hi/index.html

Documents

Neighbor Island Medical Service Network Chapter 8: … · Direct access to the contracted primary specialties of Ob/Gyn, ... Neighbor Island Medical Service Network 5 ... inguinal