Documents and Forms

Links to important forms and documents:

Provider Directories

Provider Options by Location:

In Colorado:  Find Kaiser Permanente providers and statewide network of contracted providers.

In Other Kaiser Permanente States:  The Choice PPO’s First Health Network provides access to care in the Kaiser Permanente states of CA, GA, HI, MD, OR, VA, WA, and DC.

In Non-Kaiser Permanente States:  The Cigna Healthcare^SM PPO Network* only provides access to care in non-Kaiser Permanente states.

*The Cigna Healthcare PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna Healthcare PPO for Shared Administration. Cigna Healthcare is an independent company and not affiliated with Kaiser Foundation Health Plan, Inc., and its subsidiary health plans. Access to the Cigna Healthcare PPO Network is available through Cigna Healthcare’s contractual relationship with the Kaiser Permanente health plans. The Cigna Healthcare PPO Network is provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company. The Cigna Healthcare name, logo, and other marks are owned by Cigna Healthcare Intellectual Property, Inc.

Network Access Plans

Colorado Choice PPO Network Access Plan

Formularies

KPIC Colorado POS and PPO Formulary

KPIC Colorado POS and PPO Formulary en espanol

Prior Approval forms

Medical:

Prior Authorization Form for Services within CO

Permanente Advantage Pre-Certification Form

Pharmacy: Pharmacy Prior Authorization Request Form (KPIC MRF)

MedImpact Standard Commercial Guidelines

Oncology Step Regulation PA Guidelines

Claim forms

Medical: Choice Products Medical Claim Form

Pharmacy: Drug Reimbursement Form

Other documents and forms

Choice PPO New Member Guidebook

Preparing for your Appointment with a Non-Kaiser Permanente Provider