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 of Group Health's Medicare Advantage plan population. In an ever-changing environment, one of the Department's greatest challenges is meeting the consumers' needs while maintaining compliance with the Centers for Medicare and Medicaid Services.

Our Department handles:

  • Enrollment and disenrollment requests of our members
  • Plan changes
  • Tracking of the End Stage Renal Disease (ESRD) Medicare+Choice population
  • Reconciliation of the Reply Report List and Monthly Membership Report from the Centers for Medicare and Medicaid Services (CMS, formerly known as HCFA)
  • Transmissions to CMS of involuntary disenrollments due to service area and delinquency issues
  • Medicare Advantage Plan Institutional and Hospice tracking in conjunction with other departments
  • Age-in process for current members aging into Medicare
Revised 11/13/2014

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.