News and Highlights

HEDIS Insight: Pediatric & Adolescent Well-Visits and Immunizations (PDF)

Quick reference guide of HEDIS measures for pediatric and adolescents includes coding information and tools for improving performance.

Provider Update: September 2016 (PDF)

Claim payment card, FluMist not recommended for 2016-2017 season, drug formularies, and more.

Provider E-News

See monthly clinical practice and business updates.

Changes to Medical Necessity Review Criteria for Group Health Options PPO (PDF)

See what services require review beginning Sept. 1.

Pharmacy News: July 2016 (PDF)

Latest pharmacy news from Group Health for providers.

Formulary Decision Highlights: June 2016 (PDF)

Highlights from the June 8 meeting.

New Payment Policy: Pharmacist Reimbursement (PDF)

See the latest updates, effective June 1, 2016.

August Clinical Tips

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

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.

Modifiers Payment Policy (PDF)

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

Omni PPO Plans

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

Annual NCQA Notification

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

 
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