News and Highlights

Inpatient Admission Form Not Available

If you need to send an inpatient notification to Group Health, please send it via our secure fax number: 206-901-6109.

Claims Systems Enhancement Notice

Group Health is implementing automation into our claims processing system to ensure a quicker turn-around time in payment. See the June eNews (PDF).

Changes to Medical Necessity Review Criteria (PDF)

Effective Sept. 1, changes to medical necessity review criteria for transcutaneous electrical nerve stimulator may affect coverage of services.

Change in Reimbursement for Fetal Non-Stress Tests (PDF)

Effective Oct. 1, Group Health will not separately reimburse for these tests, CPT code 59025.

July Clinical Tips

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

Group Health's Bremerton Location Is Closing

The Bremerton East Medical Center is closing July 30, and services are moving to Group Health's Silverdale and Port Orchard clinics. Learn more (PDF).

Pharmacy News: July 2015 (PDF)

Asthma medication adherence, use of suvorexant, pharmacologic options for alcohol use disorder, and more.

Drugs Requiring Prior Authorization Approval

Effective Sept. 1, the following drugs require prior authorization:
Imiglucerase (Cerezyme), Taliglucerase Alfa (Elelyso), and Velaglucerase Alfa (VPRIV) (PDF)
Alemtuzumab (Lemtrada) (PDF)
Testosterone Cypionate, Testosterone Enanthate, and Testosterone Undeconoate (Aveed) (PDF)

Nivolumab, Pembrolizumab, and Ramucirumab Not Covered (PDF)

Effective Sept. 1, nivolumab (Opdivo), pembrolizumab (Keytruda), and ramucirumab (Cyramza) will not be covered.

Formulary Decision Highlights: June 2015 (PDF)

Highlights from the June 10 meeting.

Improved Process for Provider Reconsiderations on Its Way

Effective Aug. 3, Group Health's process is changing for requesting a provider reconsideration when there is disagreement on the final disposition of a claim.

Provider Update: June 2015 (PDF)

ICD-10 implementation, updated depression and tobacco use guidelines, new sleep disorders guideline, pharmacy updates, and more.

Group Health Contracted Hospitals (XLS)

List identifying whether contracted hospitals are religiously affiliated. For questions about services, contact the hospitals or Dr. Paul Sherman at Group Health.

'Ensuring Comprehensive Care at Religiously Affiliated Hospitals'

This member-approved advisory resolution reaffirm's Group Health's commitment to provide a full spectrum of legal, covered, and medically appropriate services, including reproductive health and end-of-life care.

 
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Recommendations for clinicians and patients about specific clinical circumstances.
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Fraud, Waste, Abuse (FWA) Prevention Training

To complete Group Health's training, review our
Prevention of FWA Training slide show (PDF)