1. Absence Documentation Services (ADS) Elsa I. Gutierrez - Director of Absence Documentation Services (ADS) John D. George - Group Leader for Release of Information (SCAL) Jefrey R. Brown -Business Consultant (SCAL) | © 2013 Kaiser Permanente, Absence Documentation Services (ADS) Presentation for:

2. Release of Information Process Flow 2 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 21, 2015

3. Kaiser Permanente – California Short Term Disability Claim Process Disability Insurance Carrier to submit request for Attending Physician Statement/Substantiating Records release to KP Medical Center Release of Information Unit via us mail or email  Use Initial Request Email template with standard subject line  Indicate purpose of request and scope of medical information required  Include a completed authorization that has been signed by the patient that authorizes: ―Attending Physician Statement to be completed ―Substantiating Medical Records to be included in release KP ROI Unit will process request within 5 business days of receipt of complete request  If request is incomplete or missing elements, Disability Carrier will be notified by email within 24 business hours  For initial claims: ―Ideally, specific dates will be provided by the disability insurance carrier in their request. Records available between the dates specified will be provided. ―If no dates are provided, records from the onset of disability to present will be released in lieu of form completion  Records will include physician office visits and for inpatient, the admission/discharge summaries and operative reports ―Pregnancy claims will receive the Kaiser standard Physician Certification short form (unless time off is due to complications)  Completed forms/records will be sent via secure file transfer/secure email to Disability Carrier using standard email template 3 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 21, 2015

4. Email template – Disability Carrier Initial Request Email (Short Term Disability) Subject:  Short Term Disability Attending Physician Statement Request– [Carrier and/or Employer Name] Claim # Body:  Enclosed is a request for an Attending Physician Statement and/or substantiating medical records to be completed for [Patient Name], [ list two of the following identifiers: MRN, DOB, Address] for an initial short term disability claim related to [indicate reason for time off/injury/treatment]  Records from [date] to [date] are requested  A completed authorization signed by the employee has been included  Attach completed/signed authorization form 4 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 21, 2015

5. Email template – KP Release of Form/Records for Short Term Disability Subject:  Request for information from Kaiser Permanente [Identifier / Claim # if known ] (PHI) Body:  Enclosed is information requested that has been authorized for disclosure by [Patient Name], [MRN], [DOB], on [Date]  Please download the attached file to access this information.  If you have any problems accessing this information reply to [KP email]  Attach copy of completed form and any associated medical records 5 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 21, 2015

6.  The Kaiser Permanente, Absence Documentation Services (ADS) unit launched, June 4, 2012  The Absence Documentation Services (ADS) provides a central point of contact for escalation process for non-occupational disability requests  The ADS office is located in Rancho Cucamonga, CA, with a satellite office in Oakland, CA Absence Documentation Services (ADS) Overview | © 2013 Kaiser Permanente, Absence Documentation Services (ADS)August 21, 2015 6

7. Absence Documentation Services - Defined  Provides an escalation service for disability management and return to work for health issues that are not work related.  Absence documentation problems are more often related to illness or injuries, however, it includes a broad array of clinical issues, including behavioral health, maternity, orthopedic, etc.  Absence Documentation Services (ADS) assists in providing documentation for employees who are able or not able to return to temporary or modified work after an injury, illness or disability 7 August 21, 2015| © 2013 Kaiser Permanente, Absence Documentation Services (ADS)

8. Employer Group or TPA notifies Absence Documentation Services (ADS) of request for medical records. The Employer Group or TPA will contact ADS:  Secure email address ADS@kp.org for status requestsADS@kp.org  Toll free number to contact ADS (888)900-9093  Authorization forms can be forwarded to the member when necessary, to expedite the process  Requests to escalate should be sent to ADS after 5 business days, once a valid Authorization form is received by the Facility  Our Specialists will work with you to fulfill the request and provide status updates Absence Documentation Services - Process 8 August 21, 2015| © 2013 Kaiser Permanente, Absence Documentation Services (ADS)

9. Absence Documentation Services (ADS) 9 August 21, 2015| © 2013 Kaiser Permanente, Absence Documentation Services (ADS)

10. Client notification of Absence Documentation Services - Provide County of Los Angeles with an ADS Welcome Kit, which includes:  Welcome Letter  New email address ADS@kp.org for Intake Request formsADS@kp.org  FAQ’s regarding Absence Documentation Services (ADS)  A contact list for the Absence Documentation Services (ADS) team Next Steps: 10 August 21, 2015| © 2013 Kaiser Permanente, Absence Documentation Services (ADS)

11. Absence Documentation Services (ADS) For more information or any questions please contact: Absence Documentation Services (ADS) (888)900-9093 ads@kp.org Or contact us directly: Jefrey R. Brown, Business Consultant (SCAL) (909)367-7792 – Direct Line (909)238-3016 – Mobile jefrey.r.brown@kp.org Cicely Cisse, Business Consultant (NCAL) (510)625-3926 – Direct Line (510)459-4992 – Mobile cicely.cisse@kp.org Elsa Gutierrez Director of Absence Documentation Services (ADS) (909)367-7461 – Direct Line (909)900-5941 - Mobile elsa.i.gutierrez@kp.org 11 August 21, 2015| © 2013 Kaiser Permanente, Absence Documentation Services (ADS)

12. QUESTIONS ? 12 August 21, 2015| © 2013 Kaiser Permanente, Absence Documentation Services (ADS)