Group Health Government Programs Department

Group Health's Government Programs department offers resources for our contracted providers regarding Medicare and other state and national aid programs.

Medicare

The Medicare Enrollment and Reconciliation Department handles enrollment, disenrollment, compliance, and reconciliation processes for Clear CareŽ, Group Health's Medicare Advantage plan members. The department can address the following issues:

  • Enrollment and disenrollment requests from members
  • Plan change requests from members
  • Tracking of the End Stage Renal Disease (ESRD) Clear Care population
  • Reconciliation of the Transaction Reply Report and Monthly Membership Report from the Centers for Medicare & Medicaid Services (CMS)
  • Transmissions to CMS of involuntary disenrollments due to service area and delinquency issues
  • Clear Care plan hospice tracking (in conjunction with other Group Health departments)
  • Age-in process for current members aging into Medicare
Reviewed 12/6/2013

The Provider Manual is not intended for any use by any party other than as a resource for Group Health Cooperative's contracted providers in fulfilling their obligations under provider contracts. Group Health intends for the manual to be accurate for its intended purpose but doesn’t guarantee accuracy. Providers should comply with the terms of their provider contracts and any legal requirements in the event of an inconsistency between the manual and a requirement in their provider contracts or the law.