News and Highlights

Two Provider Forms Are Not Available

The Inpatient Admission Form and the Provider Site Feedback Form are unavailable.

If you need to send an inpatient notification to Group Health, please send it via our secure fax number: 206-901-6109.

Evaluation and Management Services Billed with Preventive Medicine Examinations (PDF)

Effective June 1, 2015, Group Health will reimburse evaluation and management office or home visits with modifier 25 provided to commercial members at 50 percent of the contracted allowed amount when billed with a preventive medicine examination on the same day, by the same provider.

March Clinical Tips

Check out our Clinical Pearls — short, straightforward clinical recommendations you can integrate into your daily practice.

Provider Update: March 2015 (PDF)

HEDIS medical record FAQs, pneumococcal vaccine recommendations, new lung cancer screening guideline, and more.

Drugs Requiring Prior Authorization Approval

Effective May 1, the following drugs require prior authorization before being administered in a physician's office:
Eloctate, Alprolix, and Vimizim (PDF)
Aralast, Aralast NP, Glassia, Prolastin, Prolastin C, Zemaira (PDF)
Belinostat (Beleodaq) (PDF)
Bevacizumab (Avastin) (PDF)

PET Scans and Bioengineered Skin Substitutes (PDF)

Effective April 1, Group Health is changing the medical necessity review criteria for PET scans and bioengineered skin substitutes. These changes may impact coverage of the services.

2015 HEDIS® Medical Review Season

Through mid-May, Group Health will review medical records to measure practice compliance with certain Healthcare Effectiveness Data and Information Set® (HEDIS) measures. Our reviewers may contact your office. We appreciate your help in providing access to requested medical information. More info: Medical Record Review Letter (PDF) and HEDIS Season FAQs (PDF)

Review Services Updates: January 2015 (PDF)

General and pre-authorization updates, and medical necessity review criteria changes.

Pharmacy News: January 2015 (PDF)

Lantus vs. NPH, ledipasvir-sofosbuvir, update to pneumococcal vaccine schedule, venlafaxine compared to low-dose estradiol.

 
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