News and Highlights

Summary of Benefit Documents

You may now view Summary of Benefit documents for Group Health members via our secure provider website. The root cause affecting the "view" capability has now been fixed.

New Payment Policy: Pharmacist Reimbursement (PDF)

See the latest updates, effective June 1, 2016.

June Clinical Tips

See Clinical Pearls — recommendations you can integrate into your practice.

Provider E-News

See monthly clinical practice and business updates.

Provider Update: June 2016 (PDF)

HEDIS information, provider reconsiderations, updated cancer guideline, and more.

Injectable Drugs Requiring Prior Authorization

Non-Medicare Drug List updated June 1.

New Group Health Payment Policies

Updated policy for reimbursement of fetal non-stress tests.

New Injectable Prior Authorization Approval - Elotuzumab (PDF)

Effective Aug. 8, Elotuzumab (Empliciti™) will be added to the non-Medicare list of injectable drugs requiring prior authorization.

2016 HEDIS Documentation and Coding Guidelines (PDF)

Group Health's quick reference guide of common HEDIS measures includes newly issued statin measures for patients with cardiovascular disease and diabetes.

Pharmacy News: April 2016 (PDF)

Information about drugs empagliflozin, zetia and PCSK9 inhibitors, antibiotics for acute otitis media in children, and proton pump inhibitors.

Modifiers Payment Policy (PDF)

See updated information on the P3, P4, and P5 modifiers. These do not impact reimbursement.

Formulary Decision Highlights: March 2016 (PDF)

Highlights from the March 9 meeting.

Omni PPO Plans

See what's offered, which services require preauthorization, and get information about claims submissions.

New Payment Policy: CAD for Mammography (PDF)

Group Health does not separately reimburse CAD for mammography services for all commercial members.

Annual NCQA Notification

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

 
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Responsibilities to Members