News and Highlights

Unusually High Call Volumes for PAU

We apologize for the long wait times and are working to solve the problem. In the meantime, see Provider Assistance Unit for help and more resources.

Injectable Drugs Requiring Prior Authorization

Non-Medicare Drug List updated Feb. 4.

HEDIS® Medical Record Review Season: February - May 2016

Get information and see FAQs about the HEDIS medical record review.

Changes to Medical Necessity Review Criteria for IORT (PDF)

New policy for intraoperative radiation therapy (IORT) goes into effect April 1.

Pegfilgrastim (Neulasta®) Requires Prior Authorization (PDF)

Effective April 1, pegfilgrastim will be added to the non-Medicare list of injectable drugs requiring prior authorization.

Changes to Medical Necessity Review Critera (PDF)

Effective April 1, review criteria is changing for the following: anorexia nervosa; bulima, binge, and specified eating disorders; and electroconvulsive therapy.

January Clinical Tips

Check out Clinical Pearls — recommendations you can integrate into your daily practice.

Important Information Regarding Omni PPO Patients (PDF)

Pharmacy News: January 2016 (PDF)

Considerations for medical marijuana use, flibanserin, diabetes SGLT2 inhibitors, and more.

New Group Health Payment Policies

See updated policies for Access and OMNI PPO Plans Out-Of-Network Reimbursement, and Pharmacist Reimbursement.

Annual NCQA Notification

Review updates to our guidelines, services, provider manual, and other important information.

Review Services Updates: December 2015 (PDF)

Criteria updates, approved and non-approved technology, and more.

Clarification on KPS Transition Relative to Provider Remittance Checks

Correction to messaging in the December 2015 Provider Update about the KPS transition to Group Health Options Inc.

Home Infusion Injectable Prior Authorization Updates (PDF)

See a list of medications requiring prior authorization, effective Feb. 15.

HEDIS® Insight: December 2015 (PDF)

Codes, acceptable medical records, and documentation required for colorectal cancer screening.

Provider Update: December 2015 (PDF)

Group Health to join Kaiser Permanente, update to remittance checks, pharmacy updates, and more.