absence documentation services (ads) elsa i. gutierrez - director of absence documentation services...

Absence Documentation Services (ADS)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:

Release of Information Process FlowRelease of Information Process Flow

2 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.April 19, 2023

Kaiser Permanente – CaliforniaKaiser Permanente – CaliforniaShort Term Disability Claim ProcessShort 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


Email template – Disability Carrier Initial Email template – Disability Carrier Initial Request Email (Short Term Disability)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


Email template – KP Release of Form/Records Email template – KP Release of Form/Records for Short Term Disabilityfor 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


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) Absence Documentation Services (ADS) OverviewOverview

| © 2013 Kaiser Permanente, Absence Documentation Services (ADS) April 19, 20236

Absence Documentation Services - DefinedAbsence 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 April 19, 2023 | © 2013 Kaiser Permanente, Absence Documentation Services (ADS)

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 [email protected] for status requests Toll free number to contact ADS (888)900-9093Authorization forms can be forwarded to the member when necessary, to expedite the processRequests to escalate should be sent to ADS after 5 business days, once a valid Authorization form is received by the FacilityOur Specialists will work with you to fulfill the request and provide status updates

Absence Documentation Services - ProcessAbsence Documentation Services - Process


Absence Documentation Services (ADS)Absence Documentation Services (ADS)


Client notification of Absence Documentation Services -

Provide County of Los Angeles with an ADS Welcome Kit, which includes:Welcome LetterNew email address [email protected] for Intake Request formsFAQ’s regarding Absence Documentation Services (ADS)A contact list for the Absence Documentation Services (ADS) team

Next Steps:Next Steps:


Absence Documentation Services (ADS)Absence Documentation Services (ADS)For more information or any questions please contact:

Absence Documentation Services (ADS)(888)[email protected]

Or contact us directly:

Jefrey R. Brown, Business Consultant (SCAL)(909)367-7792 – Direct Line(909)238-3016 – Mobile [email protected]

Cicely Cisse, Business Consultant (NCAL)(510)625-3926 – Direct Line(510)459-4992 – [email protected]

Elsa GutierrezDirector of Absence Documentation Services (ADS)(909)367-7461 – Direct Line(909)900-5941 - [email protected]


QUESTIONS ?


absence documentation services (ads) elsa i. gutierrez - director of absence documentation services...

Documents

purpose of request

complete request

onset of disability

standard email template

kaiser foundation health

scope of medical information

associated medical records

information reply