News and Highlights

New Group Health Payment Policies

Effective Jan. 1, updated policies for telehealth, telemedicine, and virtual care.

Provider E-News

See monthly clinical practice and business updates.

Change in Chemical Dependency Residential Review Process (PDF)

Effective Jan. 1, Group Health will make a change in our CD Residential Review Process. We will follow our actual review process, which states that we will review all CD Residential Requests for Treatment on the next business day and give a decision within 24 hours.

Site of Service Requirement for Some Injectable Medications (PDF)

Effective Jan. 16, a new site of service prior authorization is required for some drugs.

Reimbursement Change for Telemedicine Services (Commercial) (PDF)

Effective Jan. 1, Group Health will reimburse at the in-network benefit level for services rendered to members by in-network providers.

New Reimbursement for Virtual Care (Commercial) (PDF)

Effective Jan. 1, will reimburse at the in-network benefit level for services rendered to commercial members by in-network providers.

Pharmacy News: October 2016 (PDF)

Latest pharmacy news from Group Health for providers.

October Clinical Tips

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

Patient Referrals into Seattle Area

When referring Group Health patients to the Seattle area for care, we ask all referring providers to explore the clinical excellence available at Group Health Medical Centers and encourage you to select Group Health first. See Provider Update, page 4.

Prior Authorization Changes for BRCA and Lynch Syndrome Testing (PDF)

Effective Dec. 1, prior authorization is required for BRCA and Lynch Syndrome testing.

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.

Injectable Drugs Requiring Prior Authorization

Non-Medicare Drug List updated Nov. 22.

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.

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.