News and Highlights

Participate in Our PPO

Group Health Options, Inc., a subsidiary of Group Health Cooperative and a health care services contractor, is expanding its Preferred Provider Organization (PPO) physician network and we'd like you to join us. Get started today.

Welcome to the Group Health PPO Network

Get the onboarding information you need to see your Group Health PPO members beginning Jan. 1, 2014.

April Clinical Tips

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

Review Services Updates: April 2014 (PDF)

Referral request tool updates and changes to Medical Necessity Review Criteria.

Pharmacy News: April 2014 (PDF)

Q&A on Group Health recommendations vs. ACC/AHA recommendations, medication adherence, medication safety, ospemifene (Osphena): new medication review, sofosbuvir and a shifting hepatitis C treatment paradigm.

Payment Policy for Unlisted Codes

When benefits allow, Group Health will reimburse unlisted codes when services are medically necessary and a more specific code cannot be utilized.

Prior Authorization for Office-Administered Injectable Drugs

Review the Non-Medicare Drug List updated on March 19, 2014.

Formulary Decision Highlights: March 2014 (PDF)

View the Formulary Decision Highlights updated on March 12, 2014.

Payment Policy for Robotic Assisted Surgery

Group Health will not separately reimburse for the use of robotic surgical systems, including but not limited to, CPT/HPCS S2900, 20985, 0054T, and 0055T.

Provider Update: March 2014 (PDF)

Group Health congratulates network providers, members on fee-for-service with Group Health secondary, HEDIS® medical record review season, Medicare Annual Well Visit benefit and Group Health individual Medicare enrollees, and more.

Change in Facility Charges for Evaluation and Management Services (PDF)

Effective June 1, 2014, Group Health will not separately reimburse facility charges for evaluation and management services provided to commercial Managed Care Members regardless of the revenue code.

 
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Provider Manual

Quick access to the contractually binding information on this site.
Provider Manual Index

Continuing Medical Education

We offer 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)