News and Highlights

Annual NCQA Notification

Providers were recently emailed a postcard about updates to our guidelines and other important information. We encourage you to review these updates at your earliest convenience.

Prior Authorization Changes for Eylea and Lucentis (PDF)

Effective Feb. 1, 2016, prior authorization is changing for afibercept (Eylea) and ranibizumab (Lucentis).

Prior Authorization Required for Carbidopa and Levodopa Enteral Suspension (PDF)

Effective Feb. 1, 2016, carbidopa and levodopa enteral suspension (Duopa) require prior authorization.

Enhancements to ERA From InstaMed

Review several changes to InstaMed's electronic remittance advice, effective Oct. 25.

October Clinical Tips

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

Changes to Medical Necessity Review Criter for IONM (PDF)

Effective Jan. 1, changes to the medical necessity review criteria may affect coverage of services for intraoperative neurophysiolgic monitoring (IONM).

Pre-Authorization Request Fax Cover Sheet (Word)

If you must submit a pre-authorization request by fax instead of via OneHealthPort, use our standard pre-authorization request fax form.

Pharmacy News: October 2015 (PDF)

Generic drug price increases, benzodiazepine discontinuation in long-term users, LEAP trial, and more.

Provider Update: September 2015 (PDF)

ICD-10 implementation; updated asthma, diabetes, and chlamydia guidelines; pharmacy updates, and more.

Formulary Decision Highlights: September 2015 (PDF)

Highlights from the Sept. 9 meeting.

Prior Authorization for Office-Administered Injectable Drugs

Non-Medicare Drug List updated Sept. 29, 2015.

Care Management Internalizing Health Dialog Services

Group Health no longer contracts with Health Dialog, a vendor providing health coaching services. These services are now part of Care Management.

Review Services Updates: September 2015 (PDF)

Procedure notifications, updates to Transition of Care policy, ICD-10 information, and more.

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Frequently Asked Questions

Notify Us of a Change to Your Practice

Complete the appropriate form and e-mail it to Provider Services.

Contracted Provider Information Change/Update Form (Word)

Non-Contracted Provider Information Change/Update Form (Word)

Provider Manual

Contractually binding information on this site.
Provider Manual Index

Clinical Guidelines

Recommendations for clinicians and patients.
Clinical Guidelines