Knowing when to bill your Kaiser insurance clients for your mental health practice is confusing if not infuriating.  Our guide to Kaiser and Beacon billing for mental health providers will help you understand where and how to submit Kaiser insurance billing.

You’ll learn how to check eligibility and benefits for your Kaiser clients to discover where claims should be filed, what carve our policy they have and how it impacts billing, and how to get paid for Kaiser and Beacon clients.

If you’d rather say pass, consider our mental health billing service at TheraThink to take care of this nonsense for you.

Article Index:

• Kaiser vs Beacon Health Options
• Kaiser Insurance By State
• Mental Health Eligibility and Benefits Verification
• Where to File Kaiser Claims for Mental Health Billing

Kaiser vs Beacon Health Options

Kaiser Permanente (called Kaiser for short) is a large insurance and managed care consortium founded in California.  Kaiser is one of the largest nonprofit healthcare organizations in the United States.

Kaiser insurance plans serve and operate in eight states:  California, Colorado, District of Columbia, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington.

Beacon Health Options is a separate insurance company that specializes in mental health and substance abuse disorder management.  They provide EAP plans, Medicaid plans, and handle mental health billing and insurance processing for many insurance companies on their behalf in the United States.  (Source)

Beacon Health Options provides a “carve out” service to larger insurance companies to handle just the mental health services of their clients insurance plans.  As such, in these cases, Kaiser Permanente may “carve out” their mental health insurance coverage to Beacon Health Options.

Kaiser Insurance By State

The table below outlines the different names of the various departments for electronic claims submission at Kaiser.  Different states and plans have different payer IDs and claims addresses for CMS1500 claims filing.  We always recommend calling their insurance plan based on the phone number on the back of their card to ask about their eligibility and benefits — specifically where to file claims and what payer ID to use.

You can reference the table of Kaiser insurance billing departments to confirm the results of your benefits verification call.

(Source) (Source)

When Do Kaiser Claims Go to Beacon Health Options?

Beacon Health Options provides mental health coverage for some Kaiser clients in Colorado and California.  (Source) (Source) (Source) (Source)

Always check eligibility and benefits to determine where to file claims, using the script below.

Mental Health Eligibility and Benefits Verification

From our article “How to Verify Eligibility and Benefits for Mental Health Providers“:

1. “I’m looking to verify eligibility and benefits for a new patient for Outpatient Mental Health Provider services”
2. “Before I begin, I want to make sure I am an in-network provider for your panel, can you please check?”
3. “Great, and I want to verify you have the correct address for my office, it’s _________”
4. “The subscriber ID, date of birth, and first and last name are..”
5. “I want to confirm there are no limits or authorizations required for this patient”
6. “I wanted to confirm the following CPT codes: 90791, 90834, 90837, 90847” (add any other CPT codes you bill for here)
7. “What’s the copayment or coinsurance for this patient?”
8. “Does this patient have an outstanding deductible?”
9. “What address should I send my claims to?”
10. “What is the Payer ID for electronic claims?”
11. “Does a different department or subcontracted insurance handle this plan?”
12. (If yes) “What address should I send my claims to?”
13. (If yes) “What payer ID should I use for electronic claims submission?”
14. “Thank you so much for your help, can you please provide me your name and a reference ID for this call for my records?”

Kaiser Mental Health Claims Address by State [2022]

Colorado Kaiser Permanente

Beacon Health Options Claims

PO Box 1854

Hicksville, NY 118021850

Payer ID:  VALOP

Kaiser CSI – California Select for Individuals

PO Box 30547

Salt Lake City, UT 841300547

Payer ID:  94320

Kaiser Foundation Health Plan of Colorado

Beacon Health Options Claims

PO Box 1854

Hicksville, NY 118021850

Payer ID:  VALOP

Kaiser Foundation Health Plan of Georgia

PO Box 370010

Denver CO 802379998

Payer ID:  21313

Kaiser Foundation Health Plan of Northern CA Region

PO Box 930321

Wixom, MI 483930321

Payer ID:  94135

OR

Beacon Health Options Claims

PO Box 1854

Hicksville, NY 118021850

Payer ID:  VALOP

Kaiser Foundation Health Plan of Southern CA Region

PO Box 30547

Salt Lake City, UT 841300547

Payer ID:  94134

OR

Beacon Health Options Claims

PO Box 1854

Hicksville, NY 118021850

Payer ID:  VALOP

Kaiser Foundation Health Plan of the Mid-Atlantic States

PO Box 371860

Denver, CO 802375860

Payer ID: 52095

Kaiser Foundation Health Plan of the Northwest

PO Box 370050

Denver, CO 802370050

Payer ID:

Kaiser Foundation Health Plan of Washington

PO Box 34585

Seattle, WA 981241585

Payer ID:  91051

Kaiser Permanente Health Plan of Hawaii

PO Box 378021

Denver, CO 802378021

Payer ID:  94123

Kaiser Self-Funded

PO Box 30547

Salt Lake City, UT 841300547

Payer ID: 94320

Conclusion

This stuff sucks!  Hopefully we’ve been helpful in figuring out where your Kaiser claims for mental health services end up going, and if you’d rather hire a professional, consider learning more about billing service at TheraThink.  We figure this out for you!