News and Highlights

EDI Interface Systems Downtime

On Saturday, May 9, between 8 a.m.-8 p.m., our electronic data interchange system (EDI) will be unavailable during a system upgrade. Batch and real-time transactions will be delayed or unavailable; this includes benefits and eligibility lookups, referral requests, and claims status inquiries.

Two Provider Forms Are Not Available

The Inpatient Admission Form and the Provider Site Feedback Form are unavailable.

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

April Clinical Tips

Check out our Clinical Pearls — short, straightforward clinical recommendations you can integrate into your daily practice.

Pharmacy News: April 2015 (PDF)

Patient medication adherence, alternatives to Colchicine for treating gout, FDA alert for Chantix, and more.

Prior Authorization for Office-Administered Injectable Drugs

Review the Non-Medicare Drug List updated on Dec. 24, 2014.

'Ensuring Comprehensive Care at Religiously Affiliated Hospitals'

A member-sponsored advisory resolution, reaffirming Group Health's longstanding commitment to provide a full spectrum of legal, covered, and medically appropriate services, including reproductive health and end-of-life care, has been approved by our voting members.

Formulary Decision Highlights: March 2015 (PDF)

View highlights from the meeting on March 11, 2015.

Evaluation and Management Services Billed with Preventive Medicine Examinations (PDF)

Effective June 1, Group Health will reimburse evaluation and management office or home visits with modifier 25 provided to commercial members at 50 percent of the contracted allowed amount when billed with a preventive medicine examination on the same day, by the same provider.

Provider Update: March 2015 (PDF)

HEDIS medical record FAQs, pneumococcal vaccine recommendations, new lung cancer screening guideline, and more.

Drugs Requiring Prior Authorization Approval

Effective May 1, the following drugs require prior authorization before being administered in a physician's office:
Eloctate, Alprolix, and Vimizim (PDF)
Aralast, Aralast NP, Glassia, Prolastin, Prolastin C, Zemaira (PDF)
Belinostat (Beleodaq) (PDF)
Bevacizumab (Avastin) (PDF)

2015 HEDIS® Medical Review Season

Through mid-May, Group Health will review medical records to measure practice compliance with certain Healthcare Effectiveness Data and Information Set® (HEDIS) measures. Our reviewers may contact your office. More info: Medical Record Review Letter (PDF) and HEDIS Season FAQs (PDF)

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Provider Manual

Contractually binding information on this site.
Provider Manual Index

Continuing Medical Education

Programs to maintain and enhance professional skills.
CME course list

Clinical Guidelines

Recommendations for clinicians and patients about specific clinical circumstances.
Clinical Guidelines

Fraud, Waste, Abuse (FWA) Prevention Training

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