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PROVIDER RESOURCES

Provider resources for serving Common Ground Healthcare Cooperative ETF members

PROVIDER PORTAL

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• Prior Authorization Forms

• Prior Authorization Guidelines

• Electronic Remittance and Payment

• Other

• Behavioral Health Inpatient Admission – ETF CGHC
• Cardiac, Pulmonary Rehab – ETF CGHC
• Day Treatment, Partial Hospitalization – ETF CGHC
• DME – ETF CGHC
• Home Health – ETF CGHC
• Inpatient Admission – ETF CGHC
• Intensive Outpatient Treatment – ETF CGHC
• Neuro, Psychological Testing – ETF CGHC
• Out of Network – ETF CGHC
• PT-OT-ST – ETF CGHC
• Service, Procedure – ETF CGHC

• 2023 Prior Auth Guidelines – ETF CGHC

• Electronic Data Partner List – ETF CGHC
• Electronic Remittance Advice Form – ETF CGHC
• GHC Electronic 270_271 Setup Form – ETF CGHC
• GHC Electronic 276_277 Setup Form – ETF CGHC
• GHC Electronic Claims 837 Setup Form – ETF CGHC
• Provider ACH Credits Enrollment Form – ETF CGHC

• Medical Claim Notes Form – ETF CGHC
• Provider Appeal Form – ETF CGHC
• Provider Portal Access Authorization Form – ETF CGHC

Group Health Cooperative of Eau Claire
2503 N. Hillcrest Pkwy. Altoona, WI 54720
Phone: (833) 742-0952
TTY 711
Fax +1 (715) 836-7683

Patient Access & Interoperability

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Member Rights & Responsibilities (PDF)

Nondiscrimination Policy (PDF)

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